EmailMe Form - REGISTRATION: Iowa Soccer AGM

Name *

First Last

My Club's name *

Email *

My position with the club *

President

Board Member

Paid Staff

Other

Cell/Best Phone # *

### - ### - ####

I will attend the Iowa Soccer AGM *

Yes

No

If I am unable to attend the meeting, my club would like to allow a proxy vote

Yes - we declare Board President Gary Buelt to represent our proxy

Yes - we declare another individual to cast our proxy vote (please list individual and affiliation below)

No - we prefer not to have a proxy vote

Please list the individual and the club to which they belong that you wish to vote your proxy