2009-2010 AGM/Proxy form

'''Form of Appointment of Proxy.'''

I,
	(name)

of
	(address)

being a member of Wikimedia Australia Inc.


appoint
	(name of proxy holder)/Chair*


being a member of that Incorporated Association, as my proxy to vote on my behalf at the *annual/*special general meeting of the Association to be held on—

	(date of meeting)

and at any adjournment of that meeting.

My proxy is authorised to vote *in favour of/*against the following resolution: [insert details of resolution] or act on their own discretion. (delete as appropriate.)


Signed


Date


*Delete if not applicable
__________________