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Proxy Authorisation for HINZ AGM

If you are unable to attend the 2012 HINZ AGM, you can use this form to authorise another HINZ member to vote on your behalf.

You must complete this form no later than 26th October 2012.

Fields marked with an * are required
* Last name
* First name
* I authorise the following person to represent my vote at the 2012 HINZ AGM
Enter the last name, first name of your proxy
* Signed
Attach a copy of your signature