This Proxy Statement is for ICG members who will not be attending the Annual Meeting at Costume-Con.
If you want to vote, print and complete the form and give it to someone who will be attending. You must
sign this form for it to be valid.

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International Costumers' Guild 20__ Annual Meeting Proxy Assignment Form


On this _____________ day of __________________, 20___, I,____________________________,

assign my vote to and authorize the below named member of the International Costumers' Guild,

belonging to ____________________________ Chapter, to represent me in all business coming before

the 20___ Annual Meeting of the International Costumers' Guild.

Assignee Name*: _________________________________________________________________

Address: ________________________________________________________________________

City: ____________________________________________________________________________

State/Province: ZIP/Postal Code: ______________________________________________________


Assigner Name**: _________________________________________________________________

Address: ________________________________________________________________________

City: ____________________________________________________________________________

State/Province: ZIP/Postal Code: _______________________________________________________


Signature: _________________________________________________________________________


*Who you are authorizing to vote on your behalf.
**Your name.