VIFPA Proxy Form

Vancouver Island Fire Protection Association

(the “Association”)

The undersigned, being a voting member in good standing of the Association, hereby appoints ________________________________________________________________________ , or failing him or her, ________________________________________________________________________ , as proxyholder for the undersigned to attend, act and vote for and on behalf of the undersigned at a general meeting of the Association to be held on the _______ day of _____________________, 2021 , and at any adjournment thereof.

Signed this _______ day of _________________________, 2021

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Signature
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Print name

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Company Name