ASBrS 2021 Proxy and Ballot

ASBrS ANNUAL BUSINESS MEETING PROXY AND BALLOT

ASBrS ANNUAL BUSINESS MEETING

SATURDAY, MAY 1, 2021
PROXY AND BALLOT

Question Title

* First Name

Question Title

* Last Name

Question Title

* Email Address

Question Title

* I do hereby grant my proxy to Hiram Cody, III, MD, ASBrS bylaws committee co-chair, to cast my vote at the Annual Business Meeting on Saturday, May 1, 2021. I understand that this
proxy may be used to establish a quorum at the Annual Business Meeting or any adjournment thereof.

Yes

No

Question Title

* I direct that this proxy be used only to establish a quorum and not for the election of members to the Board of Directors.

OR

I wish to cast my vote for the following members for the Board of Directors:

I direct that this proxy be used only to establish a quorum and not for the election of members to the Board of Directors.

President: Dr. Julie A. Margenthaler

President-Elect: Dr. Nathalie G. Johnson

Member-at-Large: Dr. Terry Sarantou

Other (please specify)