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Islamic Center of Federal Way
3304 S 272nd St — Federal Way — 98033
— E-Mail: [email protected]
Date: March _ _, 2015
PROXY FORM
TO WHOM IT MAY CONCERN
Dear Election Commission/ Board of Directors:
I, ___________________________________________, am a regular / Life member of the Islamic
Center of Federal Way, Federal Way, WA. Due to the following reason(s), I will not be able to attend
physically to cast my vote for the ICFW Election 2015 to be held on March 28, 2015.
Professional business trip to out of the City
Family urgent occupations
Other urgent matters
I hereby authorize _____________________________________, my spouse / brother / sister/
uncle/friend to represent and proxy me in the ICFW 2015 election/ voting process.
Jazakallahu Khaira.
(Signature)___________________________________
(Name)
Address: _________________________________
___________________________________