KBLA Proxy Designation Form

I, the undersigned, a member in good standing of the Kahshe and Bass Lakes Association (the "Association"), hereby appoint my proxy to attend, participate, act, and vote on my behalf at the Annual Meeting of Members of the Association, to be held on the date specified below. By completing this form, I acknowledge that it constitutes my digital signature.

Email *
KBLA Voting Member — First & Last Name *
Proxy — First & Last Name *
Date of AGM *
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A copy of your responses will be emailed to the address you provided.
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