I / WeFull name(s)*, of club name* Golf Club being a member / members of the above named club, hereby appoint,   
First Name*   Last Name*   of   club name* , as my / our proxy to attend, vote and speak in my / our behalf at the General Meeting of Worcestershire County Golf Limited on   Date .  The proxy must be received at least 48 hours prior to the meeting time and date.
Unless otherwise instructed, the proxy may vote as he thinks or abstain from voting.