North Carolina Society of Surveyors, Inc.
P.O. Box 10128, 410 Oberlin Road, Suite 304
Raleigh, North Carolina 27605
Telephone 919-833-9808
Fax 919-833-9848
PROXY FORM
TO:		NCSS OFFICE
FROM:	___________________________Chapter President
	___________________________Chapter
SUBJECT:	Representative for ____________________Board of Directors Meeting
I WILL NOT BE ABLE TO ATTEND THIS NEXT BOARD OF DIRECTORS 
MEETING.
__________________________________WILL ATTEND IN MY PLACE TO REPRESENT 
THE CHAPTER.

_________________________________
Signed
_________________________________
Date

NCSS SOCIETY OFFICE FAX:		919-833-9848