CAAS Voting Authorization

[please copy this form onto school letterhead before filling out]

Date _________________________

To Whom It May Concern:

 This is authorization for :

___________________________________________________

to represent our school as the voting delegate for the 2004-2005 school year for any decisions that must be voted on by the member schools of the Chess Association for Arkansas Schools.

__________________________         ______________________

Supt. or Principal (Printed Name)                Supt. or Principal Signature

School District Name

Address

City, State, Zip

Return Completed form with membership payment to: Chess Association for Arkansas Schools, W.D. Mills Education Service Cooperative, P.O. Box 850, Beebe, AR 72012, fax: (501) 882-2155