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|align = "justify"|<font color="#008000"><font size = "5"><center>'''THAMES DITTON LAWN TENNIS CLUB'''</center></font></font><br><center>Founded 30th October 1882</center>
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<center>'''Weston Green Road, Thames Ditton, Surrey, KT7 OHX'''</center>




I    ………………………………………………………………………………………………………………………………………………… (full name)

being a fully paid up adult member of this club, appoint

……………………………………………………………………………………………………………………………………………………    (full name)

to vote on my behalf at the AGM 


Signature    ……………………………………………………………………………………………………………………
		

Address      ……………………………………………………………………………………………………………………………………………………


Please return the completed and signed form to either the Secretary &mdash; Martha Gordon, 35 Weston Road, Thames Ditton KT7 0HN &mdash; or to the Clubhouse post box at the above address.

Thank you.