This Proxy Statement is for ICG members who will not be attending the Annual Meeting at Costume-Con. If you want to vote, complete the form and give it to someone who will be attending.

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International Costumers' Guild 20__ Annual Meeting Proxy Assignment Form

On this _____________ day of __________________, 20__, I,_________________________, assign my vote to

and authorize the below named member of the International Costumers' Guild, belonging

to ____________________________ Chapter, to represent me in all business coming before

the 20__ Annual Meeting of the International Costumers' Guild.

Assignee Name*:

Address:

City:

State/Province: ZIP/Postal Code:

Assigner Name**:

Address:

City:

State/Province: ZIP/Postal Code:

Signature:

*Who you are authorizing to vote on your behalf.

**Your name.