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

__________________