2010-2011 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/Secretary[1]

also being a member of that Incorporated Association, as my proxy to vote on my behalf at the 2010-2011 Annual General Meeting of the Association to be held on Sunday 19th September 2010 and at any adjournment of that meeting.

My proxy is authorised to vote in favour/against[1] the following resolution: [insert details of resolution] or to act on their own discretion.[2]

Signed

Date

Note: A proxy vote may only be given to a person who, at the time of the meeting, is a current financial member of Wikimedia Australia.

[1] Delete whichever not applicable

[2] You may limit your proxy to vote as you specify or to act at their own discretion. Where no limitation is stated, the proxy is entitled to vote according to his or her judgement.