AGM Proxy Form

This form nominates a proxy on your behalf, to attend and vote at the annual OMBA general meeting.

Granter's Name

Granter's Email

Granter's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Proxy's Name

Proxy's Email

Layout Comments Address

Proxy's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Agreement

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

By way of this proxy, I grant permission to the individual listed in the “Proxy’s Name” field to act on my behalf in the event of my absence.

Additional Comments