TANDANYA NATIONAL ABORIGINAL CULTURAL INSTITUTE PROXY FORM Please refer to the requirements of the TANDANYA National Aboriginal Cultural Institute (TANDANYA) Constitution for the purposes of completing this Proxy Form (Form). Member Information I (Insert Member Full Name): Address: Phone: Email Address: Being a Member of TANDANYA hereby appoint the following person as my Proxy entitled to vote for me on my behalf at the ENTER MEETING DATE Annual General Meeting of TANDANYA: Full Name of Proxy: Address of Proxy: Proxy appointments may be lodged by lodging a completed Proxy Form by email to INSERT EMAIL (during business hours) INSERT TIME DATE. If you have any issues lodging a completed Proxy Form please contact us immediately on INSERT PHONE NUMBER Important Information In accordance with the TANDANYA Constitution: A Member shall be entitled to appoint in writing a natural person to be a proxy, and attend and vote at any meeting of the Association. No one person may be entitled to hold more than one proxy delegation. __________________________ __________________________ Name of Member Signature of Member __________________________ Date Liability limited by a scheme approved under Professional Standards Legislation. Liability limited by a scheme approved under Professional Standards Legislation.