Contact - 100 Men Who Care

I am contacting about:*
- General Enquiry
- Proxy Vote
- Become a Sponsor
- Membership Withdrawal
Name*
First Last
Email*
Phone*
What form of sponsorship would you like to provide?
Enquiry
Reason for Resignation
Proxy Vote

I, the undersigned, hereby acknowledge that I am a member in good standing with 100 Men Who Care Whistler and that the person designated below has the authority to vote for me at the 100 Men Who Care Whistler meeting on the date specified below. I understand that if my donation payment is not received prior to the meeting, via Charitable Impact, this ballot will not be issued.
Name of Designated Voter
First Last
Date of Meeting
MM slash DD slash YYYY
Signature*
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Date*
MM slash DD slash YYYY
Phone
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Proxy Vote