2022 Queensland branch AGM proxy form

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This form once submitted will permit the person named to act as your proxy at the 2022 Queensland branch AGM. If you have any questions regarding this form please contact jason.mckenzie@fabian.org.au

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Name

Membership number

Being a current financial member of the Australian Fabians (2022/2023), I do hereby constitute and appoint: (Write the full name of the person you are seeking to hold your proxy.)

I note:

The person selected above, is also a current financial member of the Australian Fabians, as my proxy at the Queensland Branch Annual General meeting of the Australian Fabians on 17 of December, 2022, or any continuation or adjournment thereof, with full power to vote and act for me and in my name, place and stead, in the same manner, to the same extent and with the same effect that I might were I personally present, giving to them full power of substitution and revocation, and I hereby revoke any other proxy heretofore given by me.

By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. (Please enter your initials.)

Send me a copy of my responses.

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