Form

Address*

By lodging this online form, I confirm that I am a member of the Submarine Institute of Australia Inc and that my membership is fully paid until the date shown below.
Membership Validity*
- Day - Month Year
Please select all that apply:*

Apology Note a proxy
I assign my Proxy to
First Name Last Name
Proxy e-mail address
a member of the Submarine Institute of Australia Inc as my proxy to vote for me on my behalf at the general meeting of the Association (Annual General Meeting or other General Meeting, as the case may be) to be held on Thursday 11 November 2010 and at any adjournment of that meeting.
My proxy is authorised to vote

in favour of against at his/her discretion in respect of
the resolution:
or any resolution

Yes
Notes:
1. Any person may only hold a maximum of five proxies.
2. A proxy may not be given to a person who is not a member of the Association.
Please complete the word(s) as displayed in the box (including spaces if applicable)*
Should be Empty:

NOTIFICATION OF APOLOGY AND/OR ASSIGNMENT OF PROXY