Fill and Sign the Sample of a Proxy Form

Member's General Proxy for Meetings of the Members of a Nonprofit Corporation Proxy for _________________ (Name of Corporation) ____________________ (Name of Member) , a Member of ______________________ (Name of Corporation) , a ________________ (name of state) nonprofit corporation, hereby appoints __________________ (name of proxy holder) his attorney in fact to vote his membership interest in _______________________ (Name of Corporation) at any meeting of Members, for a period of (e.g., period of no more than three years) ____________________ from the date of this proxy, or until the undersigned 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) ___________________________________________________________________ ____________________________________________________________________________. ________________________ (Name of proxy holder) is directed to vote this membership interest 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) (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 __________________ (date) , 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: ____________________