2024 COCA Annual Meeting & Election - Children's Oncology Camping Association

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Member Delegate Assignment Form:
It is not necessary for Member Camps to use this form if they have one or more member affiliates (volunteers or paid staff members involved with the ongoing operations or programs of the current Member Camp) attending the virtual meeting, to choose their Member Delegate.

This Member Delegate Assignment must be presented to the Secretary of COCA no later than seven (7) days in advance of the date of the 2024 COCA Annual Meeting & Election. Once this form is completed and submitted, it will be sent to the Secretary.

The undersigned, as representative(s) of the Camp designated below is a member in good standing of COCA. Name of Camp:

We wish to exercise our right to appoint a Member Delegate according to Article II, Section 5, Para 1 of COCA’s Bylaws.

The person designated below is hereby appointed as our Member Delegate and has the authority to vote for our Camp at the 2024 COCA Annual Meeting & Election to be held on a virtual Zoom call, December 10, 2024. The Member Delegate shall vote as they wish, unless otherwise instructed.

Member Delegate Representative Name:

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Member Delegate Representative Phone:

Member Delegate Representative Email:

Representative the

At least one signature is required, from a person who is a Principal organizational executive (Executive Director, Camp Director, Program Director, or similar) and/or a member of the Governing entity (Board of Directors, Advisory Committee, Medical oversight committee, or similar) for this member Camp.

Signator Name and Title:

Clear Signature

Name:

First

Last

Email:

Phone:

Date / Time:

Date

Time

By submitting this Member Delegate Assignment form I hereby attest that I hold a position at Camp as a principal organizational executive and/or a member of the Governing entity (Board of Directors, Advisory Committee, Medical Oversight Committee.)