The Australian Lebanese Historical Society Incorporated

I, ....................._{full name}......................... of ..........................................

....................._address............................................................................

being a member of The Australian Lebanese Hisorical Society Incorporated hereby appoint

.............._{full name} ......................................................................

of ..............._address....................................................................

being a member of The Australian Lebanese Historical Society Incorporated, as my proxy for me on my behalf at the general meet of the Society (annual general meeting or special general meeting, as the case may be) to be held on ................................................. day of ................................ ..................................................._{month and year} . ......................... and at any adjournment of that meeting.

.

............................................
Signature of member appointing proxy

.............................................
Date

.

NOTE: A proxy may not be give to a person who is not a member of the Society.