BRITISH SOCIETY OF MEDICAL AND DENTAL HYPNOSIS (BSMDH) – SCOTLAND

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FORM OF PROXY - GENERAL  SEC17-

PLEASE PRINT, COMPLETE AND POST TO:

Dr H MacKinnon,  20 Borden Road. Glasgow, G13 1QX

 

THE BSMDH (SCOTLAND)

   I …………………………………………………………, (Name)

  of ……………………………………………………………………………………………., (Address)

   being a member of the above-named company, hereby appoint

**……………………………………………………………………………..(Name of Proxy)

 of ……………………………………………………………………………………(address of Proxy),

 or

**the Chairman of the Meeting

as my proxy to vote in my name and on my behalf at the annual/extraordinary general meeting of the company to be held on the   29th day of September 2007 and at any adjournment thereof.

Signed on the                day of                                     2007

 

………………………………………………………(signature)

 

** Please select either a named individual or the Chairman as proxy and delete whichever does not apply.