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102年度台南市語言治療師公會之會員大會
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會員姓名
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您是否能參加102年11月10日(周日)之會員大會?
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是
否
您是否有委託他人代為行使表決權及投票權?
若當天無法參加有委託他人繳交委託書行使表決權及投票權,亦可獲得精美禮品乙份(一名會員僅得受任於一人會員)
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請填寫您所委託之會員的姓名
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