Proxy Voting Form 8th GA

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					                    Proxy Voting Form
     Eighth General Assembly of the World Blind Union


Delegate of: __________________________________________
                (Name of Country or International Organization)

Organisation: ________________________________________________

Full Name of Delegate: _________________________________________

Full Name and Organization of Delegate to Whom Vote is to be Given:


Signature of Person Transferring Their Vote: ________________________

Name of Witness: _____________________________________

Signature of Witness: __________________________________________

Place: ______________________________________________________

Date: _______________________________________________________

Proxy forms to be submitted to WBU Office to the attention of the
Secretary General or handed to Secretary General prior to
November 12, 2012

WBU Office: 1929 Bayview Avenue, Toronto Ontario, CANADA
M4G 3E8 Fax: 1-416-486-8107


           1929 Bayview Avenue Toronto Ontario Canada M4G 3E8
                  Tel: 1-416-486-9698 Fax: 1-416-486-8107
         Email: info@wbuoffice.org Website: www.worldblindunion.org

				
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