<p> Instrument of Proxy</p><p>For BirdLife Victoria AGM 20 April 2013</p><p>[NB: If you propose to attend and vote at the AGM you are not required to return this form]</p><p>I, …………………………………………..……… of ………………………………………………………..</p><p>………………………………………………………………………………………………………. ………… being a financial member of BirdLife Australia, a member of a Victorian BirdLife Branch and entitled to vote hereby appoint ………………………………………..…………, or in their absence the Chair of the </p><p>Meeting, as my proxy to attend and vote for me at the BirdLife Victoria Annual General Meeting to be held at the All Seasons Quality Hotel,171-183 McIvor Highway, Bendigo, on Saturday 20 April 2013, commencing at 11:30am.</p><p>Agenda Item 4</p><p>That the following votes for Office Bearers are hereby cast.</p><p>In the section below, please identify your choices for the positions of Office Bearers of BirdLife Victoria from the nominations listed on the BirdLife Victoria Website http://www.birdlife.org.au/locations/all-victoria- statewide. </p><p>Convenor: ……………………………………………………………………………………………………………</p><p>Secretary: ……………………………………………………………………………………………………………</p><p>Treasurer: ……………………………………………………………………………………………………………</p><p>If nominations are not identified for an Office Bearer position, the appointed proxy shall make the choice for that position.</p><p>Signature:……………………………………………..…………Date:…………………………..</p><p>Notes</p><p>1 An Instrument of Proxy must be in writing signed by the appointer or by his/her attorney.</p><p>2 To be effective, the Instrument of Proxy must be returned or mailed to Ruth Woodrow, BirdLife Victoria Secretary, c/- BirdLife Australia, Suite 2 - 05, 60 Leicester St, Carlton, Vic 3053, to be received by 5:00 pm, 18 April 2013. A scanned copy of a signed Instrument of Proxy emailed to [email protected] by 5:00 pm, 18 April 2013 will also be accepted. </p><p>3 If you wish the person acting as your proxy to exercise his/her discretion at the meeting, you do not need to name the Office Bearers you wish to be elected.</p><p>4 An Instrument of Proxy returned without the insertion of the name of the proxy may be exercised by the Chair of the meeting.</p><p>5 This Instrument of Proxy is similar to an absentee ballot.</p><p>Note: To be a valid vote, this Instrument of Proxy must include as a minimum your name, your address, and your dated signature.</p>