Proxy Voting Format
I, [Name] of [Address](Personal, Institution or Association address), being a member of the association, appoint
[Name] of [Address] (Personal, Institution or Association address) as my proxy
to vote on my behalf at the (annual) general meeting of the association, to be held on
the _______ day of _________, _______(Day, Month, Year),
and at any adjournment of the meeting.
Signed this ________ day of ________, _______ (Day, Month, Year).
* in favor __________ * against _________
(* Strike out whichever is not wanted for each statement above. (Unless otherwise instructed, the proxy may vote as the proxy considers appropriate.)
The following are Regions of the Association: