ILGA OCEANIA AGM - PROXY VOTE FORM

ILGA OCEANIA CONFERENCE
PROXY VOTE FORM

The following are the details of the “Authorised Person” who is to exercise this proxy vote:-

Question Title

* 1. Name of the “Authorised Person”

Question Title

* 2. Address of the “Authorised Person”

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number