DEAN - Disability Education Association NSW/ACT Inc.

(Rule 3 (1))

Form of Appointment of Proxy

I,[insert full name] of [insert address] being a member of the Disability Education Association of New South Wales/Australian Capital Territory hereby appoint [insert full name of proxy] of [insert address] being a member of that incorporated association, as my proxy to vote for me on my behalf at the general meeting of the association (annual general meeting or special general meeting, as the case may be) to be held on [insert day, month and year of meeting] and at any adjournment of that meeting.

* My proxy is authorised to vote in favour of/against (delete as appropriate) the resolution (insert details).

* to be inserted if desired.

Signature of member appointing proxy

Date:

NOTE: A proxy vote may not be given to a person who is not a member of the association.