2022 AGM Proxy Nomination - Learning Difficulties Australia Inc.

2022 AGM Proxy Form

This form is for use by LDA members to nominate a proxy to vote on their behalf at the AGM.

"*" indicates required fields

Member Number*

Name*

First Last

Proxy Member Number*

Proxy Name*

First Last

Authorisation for Proxy*

I hereby authorise the nominated person above with permission to vote on my behalf at the 2022 AGM of Learning Difficulties Australia Inc.