10/15 Main Street
I, of ..
being a member of the Association
appoint of ..
as my proxy to vote for me on my behalf at the Annual General Meeting of the
Association to be held on the day of . 20 ..
And at any adjournment of the meeting.
Signed this ..day of 20 ..
This form is to be used
*in favour of
*Strike out whichever is not wanted.
(Unless otherwise instructed, the proxy may vote as the proxy considers appropriate)