http://karatemanitoba.ca Proxy form for AGM in September 2012

1. PROXY DECLARATION
I, ,
a member of Karate Manitoba in good standing, do hereby authorise
to act as my proxy and vote as she or he may see fit, subject to the following stipulations:
at the General Meeting of Karate Manitoba, being held on Saturday, September 22nd, 2012 at
1:00 p.m. at the Ramada Viscount Gort Hotel,1670 Portage Avenue, Winnipeg, Windsor
Room.
Signed: Witness:
Date: Date:
Club:
The completed proxy must be mailed to the Corporation’s secure post office address at
Karate Manitoba, P.O. Box 2519, Winnipeg, Manitoba, R3C 4A7. Proxies must be received
no later than 1:00 p.m. on September 20th, 2012. Proxies received after that time, or brought
directly to the meeting, will not be accepted.