Appointment of Proxy I*(Insert MEMBER’S name)Of* Street Address Address Line 2 City 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 ageat the general meeting on (insert date below)in relation to the following resolutions and/or nominationsat the general meeting on Date Format: 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 Date Format: DD slash MM slash YYYY Electronic Signature* By checking this box, I am confirming the above details with an electronic signature EmailThis field is for validation purposes and should be left unchanged.
