Name: _______________________________________________ 
Address: _____________________________________________ 
City/State/Zip: _________________________________________ 

I hereby appoint _____________________________________as my Agent, and provide him/her with full power and authority to vote my proxy on any matters relating to the Chicago Megabuck Investment Club meeting on____________________(Date) 

My Agent shall:

Not be liable for any loss that results from a judgment error that was made in good faith;

Not be entitled to any compensation for any services provided as Agent;

Provide an accounting for all acts performed as my Agent, if I so request, or if an authorized personal representative or fiduciary acting on my behalf makes such a request.

Signature                                                                     Date



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