Fill and Sign the General of Corporation Form

Member's General Proxy for Meetings of the Members of a Nonprofit Corporation Proxy for       (Name of Corporation)       , a Member of       , (Name of Member) (Name of Corporation) a       nonprofit corporation, hereby appoints (Name of State)       his attorney in fact to vote his membership interest in (Name of Proxy Holder)       at any meeting of Members, for a period of (Name of Corporation)       from the date of this proxy, or until the undersigned (e.g., period of no more than three years) Member revokes this proxy in writing delivered to       . (Name of Corporation) The directors nominated at the time this proxy was solicited are: (list names of directors) .                                     is directed to vote this membership interest (Name of Proxy Holder) in a manner the proxy holder determines to be most beneficial to the corporation. Witness my signature this the       day of       , 20       , ___________________________________ (Printed Name of Member)       (Signature of Member) Member's General Proxy Page 1 of 2 (Acknowledgment form may vary by state) State of       , County of       Personally appeared before me, the undersigned authority in and for the said County and State, on this       day of       , 20       , within my jurisdic tion, the within-named       , (Name of Member) who acknowledged that he executed the above and foregoing instrument. ________________________________ NOTARY PUBLIC My Commission Expires: ____________________ Member's General Proxy Page 2 of 2