Appointment of Proxy I* (Insert MEMBER’S name)Of* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code being a voting member of HURRICANE GO KART CLUB OF WA (Inc.)Appoint* (Insert PROXY’S name)who also is a member of the club, as my proxy.My proxy is authorised to vote on my behalf:* at all general meetings until I turn 18 years of age at the general meeting on (insert date below) in relation to the following resolutions and/or nominations at the general meeting on DD slash MM slash YYYY In favour:(Insert resolution Nos, brief description or nominees’ name/s)Against:(Insert resolution Nos, brief description or nominees’ name/s)Date DD slash MM slash YYYY Electronic Signature* By checking this box, I am confirming the above details with an electronic signature NameThis field is for validation purposes and should be left unchanged.
