PROXY 2021

​Know All Men By These Presents,

that I,


residing at,


being a member of the Menzies Clan Society of North America, Inc., do hereby constitute and appoint Gordon Menzies Brown, of 3385 Griffen Road, Town of Orangeville, County of Wyoming, State of New York, as my proxy to attend all the meetings of the members of said corporation to be held between the date hereof and the 1st day of January, 2021, or any continuation or adjournment thereof, with full power to vote and act for me and in my name, place and stead, in the same manner, to the same extent and with the same effect that I might were I personally present thereat, giving to said Gordon Menzies Brown full power of substitution and revocation, and hereby revoke any other proxy heretofore given by me.

Date:                          ,2021

​​​​​Member Signature :