Wikimedia Australia/Proxy form

APPENDIX 3
FORM OF APPOINTMENT OF PROXY

I,

(name & username)

of

(address)

being a member of Wikimedia Australia Inc.

appoint

(name & username of proxy holder)

of

(address of proxy holder)

being a member of Wikimedia Australia Inc., as my proxy to vote for me 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).

Signature of Proposer	Date     /     /