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November 2022 Executive Board Proxy Submission Form
PROXY ELIGIBILITY
All Proxy holders must be a Democratic State Central Committee (DSCC) delegate and
not
already an Executive Board (EBoard) member and may
not
carry more than
one
proxy.
If elected to EBoard by Assembly District Election Meeting (ADEM), your proxy must be registered in the same 2020 Assembly District as the EBoard member was elected in.
If elected to EBoard by County Central Committee, your proxy must also be a DSCC member of the same County Central Committee.
All other EBoard Rep proxies may be given to any DSCC member.
SUBMISSION
Proxy forms may be filed in advance no later than
Friday, November 11, 2022, at 5pm.
* Complete and sign the Proxy Form here: (
DOWNLOAD PROXY FORM
). Submit the completed form through the online Proxy Registration Form
or mail the completed proxy form to 1830 9
th
St, Sacramento, CA 95811,
by November 11, 2022, at 5pm.
It is recommended you give a copy of the completed form to your proxy holder even if you submit a copy in advance.
APPROVAL AND REGISTRATION
EBoard members must have paid their annual DSCC dues, register for the meeting, complete, sign and submit the proxy form, by
November 11, 2022, at 5 pm,
before being approved to represent the EBoard member.
Only EBoard members can request a waiver of dues and registration fees.
The Credentials Committee will meet on Wednesday, November 16, 2022, at 6:30 PM.
EXECUTIVE BOARD MEMBER / PROXY GIVER
EBoard Member (Proxy Giver) First Name
*
EBoard Member (Proxy Giver) Last Name
*
Registration Address
*
City
*
ZIP
*
Phone #
*
Email Address
*
County
*
Alameda
Alpine
Amador
Butte
Calaveras
Colusa
Contra Costa
Del Norte
El Dorado
Fresno
Glenn
Humboldt
Imperial
Inyo
Kern
Kings
Lake
Lassen
Los Angeles
Madera
Marin
Mariposa
Mendocino
Merced
Modoc
Mono
Monterey
Napa
Nevada
Orange
Placer
Plumas
Riverside
Sacramento
San Benito
San Bernardino
San Diego
San Francisco
San Joaquin
San Luis Obispo
San Mateo
Santa Barbara
Santa Clara
Santa Cruz
Shasta
Sierra
Siskiyou
Solano
Sonoma
Stanislaus
Sutter
Tehama
Trinity
Tulare
Tuolumne
Ventura
Yolo
Yuba
Assembly District
*
AD 01
AD 02
AD 03
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AD 05
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AD 07
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AD 21
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AD 29
AD 30
AD 31
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AD 35
AD 36
AD 37
AD 38
AD 39
AD 40
AD 41
AD 42
AD 43
AD 44
AD 45
AD 46
AD 47
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AD 49
AD 50
AD 51
AD 52
AD 53
AD 54
AD 55
AD 56
AD 57
AD 58
AD 59
AD 60
AD 61
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AD 63
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AD 65
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AD 69
AD 70
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AD 80
DSCC MEMBER / PROXY HOLDER
DSCC Member (Proxy Holder) First Name
*
DSCC Member (Proxy Holder) Last Name
*
Registration Address
*
City
*
ZIP
*
Phone #
*
Email
*
County
*
Alameda
Alpine
Amador
Butte
Calaveras
Colusa
Contra Costa
Del Norte
El Dorado
Fresno
Glenn
Humboldt
Imperial
Inyo
Kern
Kings
Lake
Lassen
Los Angeles
Madera
Marin
Mariposa
Mendocino
Merced
Modoc
Mono
Monterey
Napa
Nevada
Orange
Placer
Plumas
Riverside
Sacramento
San Benito
San Bernardino
San Diego
San Francisco
San Joaquin
San Luis Obispo
San Mateo
Santa Barbara
Santa Clara
Santa Cruz
Shasta
Sierra
Siskiyou
Solano
Sonoma
Stanislaus
Sutter
Tehama
Trinity
Tulare
Tuolumne
Ventura
Yolo
Yuba
Assembly District
*
AD 01
AD 02
AD 03
AD 04
AD 05
AD 06
AD 07
AD 08
AD 09
AD 10
AD 11
AD 12
AD 13
AD 14
AD 15
AD 16
AD 17
AD 18
AD 19
AD 20
AD 21
AD 22
AD 23
AD 24
AD 25
AD 26
AD 27
AD 28
AD 29
AD 30
AD 31
AD 32
AD 33
AD 34
AD 35
AD 36
AD 37
AD 38
AD 39
AD 40
AD 41
AD 42
AD 43
AD 44
AD 45
AD 46
AD 47
AD 48
AD 49
AD 50
AD 51
AD 52
AD 53
AD 54
AD 55
AD 56
AD 57
AD 58
AD 59
AD 60
AD 61
AD 62
AD 63
AD 64
AD 65
AD 66
AD 67
AD 68
AD 69
AD 70
AD 71
AD 72
AD 73
AD 74
AD 75
AD 76
AD 77
AD 78
AD 79
AD 80
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