<p> FORM OF APPOINTMENT OF PROXY FOR COMMITTEE OF MANAGEMENT NOVEMBER 2015</p><p>I ______(Name) of______(Address) being a financial member of the Mount Alexander Sustainability Group Inc. appoint </p><p>______(Name of proxy holder) of </p><p>______(Address of proxy holder) being a financial member of that incorporated association, as my proxy to vote on my behalf for ordinary committee of management business during August and September 2014.</p><p>I authorize my proxy to vote on my behalf at their discretion in respect of electing members to the Committee of Management and any other properly advised motions of special business.</p><p>______(Signed)</p><p>______(Date)</p><p>I am an Individual ____ Family ____ Business ____ member of MASG. (Please tick appropriate category)</p>