European Medical Students’ Association Association Européenne des Étudiants en Médecine www.emsa-europe.eu

PROXY FORM

According to EMSA Internal Rules 9.5 (“Delegation of voting right”) • •



Herewith I,

Any EMSA Representative may delegate his/her voting rights to any other EMSA Representative through a signed proxy. The maximum number of received proxies is limited to one per person.

Last Name: _



First Name: _



EMSA FMO: _



Position in EMSA FMO: _ Would like to delegate my voting right for the following meeting: EMSA Spring Assembly held from the 10th until 14th of May 2016. The Spring Assembly is taking place in Tbilisi, Georgia.

To: Last Name: _



First Name: _



EMSA FMO: _





Position in EMSA FMO: _

The carrier of this proxy shall have voting rights

on all issues only on the following issues: Date, Place: _ (invalid if dated more than 30 days prior to the first day of the specified meeting) Signature: _ • •