Appointment of Proxy Form

Name

I am a registered member from the 2021 season

Name of junior member if membership is a junior membership

I appoint to act as my proxy

I authorize my proxy to vote on my behalf on any motion that he/she/they see fit. Otherwise, I have included specific instructions on how they must vote.

Specific voting instruction

My email address

My proxy's email address

Signature (typed name)

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Note: Please fill out the fields marked with an asterisk.