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Your Name* [required]

Email* [required]

I am appointing:

Proxy Name* [required]

Proxy Email* [required]

Agreement
I confirm that the proxy I have listed may act on my behalf.

I grant permission to the individual list in the ‘Proxy Name’ field to act on my behalf in the event of my absence at the 2026 AGM.

In the event that the proxy is absent, I authorise another committee member to act on my behalf.

Signature of Agreement [required])

Date of Agreement [required]

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