Voting Member Proxy

Workplace Safety North
Annual General Meeting

Thursday, September 28, 2023
5:30 pm ET

If you have the right to vote as an EMPLOYER or WORKER representative, and if you are unable to attend the 2023 Annual General Meeting of Workplace Safety North (WSN), you may wish to have another voting delegate exercise your proxy. You may also provide this proxy to your proxy holder below who may submit the proxy upon registration. In order to do this, please complete the proxy below and return by September 18, 2023. The proxy may be revoked if you attend the meeting in person. The foregoing requirement that this proxy be signed may be satisfied by typing the name of the signatory of this proxy on the signature line.

1 Start 2 Complete

First Name *

Last Name *

I, the undersigned

E-mail *

Confirm E-mail *

Management *

Management

Non Management

Lydia Renton, the Board Chair to exercise my proxy *

Lydia Renton, the Board Chair to exercise my proxy, OR

Name (below) of alternative voting delegate to exercise my proxy,

Name of alternative voting delegate *

to attend, act, and vote on my behalf at the WSN Annual General Meeting to be held at 5:30 pm ET Thursday, September 28, 2023, and at all adjournments thereof with all powers, the undersigned would possess if personally present at the said meeting and at any such adjournments.

Dated *

Signed *

Member Company *

Member Company Address *

Leave this field blank

Voting Member Proxy

Workplace Safety North Annual General Meeting

Thursday, September 28, 20235:30 pm ET

Workplace Safety North
Annual General Meeting

Thursday, September 28, 2023
5:30 pm ET