Wikimedia South Africa/AGM1/Proxy form

FORM OF APPOINTMENT OF PROXY

I,

(name & username)

of

(address)

being a member of Wikimedia ZA

appoint

(name & username of proxy holder)

of

(address of proxy holder)

being a member of Wikimedia ZA, as my proxy to vote for me on my behalf at the annual general meeting of the association to be held in the Africa Centre, 5th Floor, 28 St George’s Mall, Cape Town on 1 September 2012 at 09:00 and at any adjournment of that meeting. My proxy is authorised to vote as specified for the following resolution(s):

To vote on candidates for the filling of the vacant board seats. For/Against/Abstain
To vote for the following candidate(s): [Delete if not required]
To vote on the resolution of conflict amongst board members, possibly including a vote of confidence on current directors. For/Against/Abstain


Signature of Proposer	Date / /