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E.il.us/onenetlibrary/3/documents/publications/wic p&p folder/proxy%20authorization%20form.doc Sample Proxy Authorization Form. WIC Program (Local Agency Name) The following individual(s) are authorized to serve as proxy for: (Participant Name) (I.D.) SAMPLE PROXY BALLOT - The American Budgerigar Society http://www.abs1.org/docs/SAMPLE%20PROXY%20BALLOT.pdf SAMPLE PROXY BALLOT I, the undersigned, hereby acknowledge that I am a member in good standing in ABS and that the person designated below.

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