“The undersigned, as a member of Chimorel Services Inc, hereby appoints the Executive Director, his/her designee, or in the event of his/her absence without appointment of a designee, then the current Chairperson/President of the Board, and then a majority of the Board of Trustees, in that order, the proxy and attorney of the undersigned, with full power of substitution to attend all meetings of members and to vote for me in my place and stead upon all matters properly coming before such meetings. The undersigned hereby ratifies and confirms all that said proxy and attorney may do by virtue hereof. The undersigned hereby reserves the right to revoke this proxy at any one or more meetings by attending and voting three votes in writing at such meeting or meetings. This proxy will remain in effect for all meetings which the undersigned does not attend and vote in writing, except that returning a ballot by mail/email shall also constitute revocation of this proxy for and only for the meeting for which said ballot is returned.”

Your signature(s) & date below accepts the terms and conditions for the membership and program(s) you have applied for as described under Chimorel’s Programs.

Chief Executive Officer________________________________ Secretary ___________________________________ Date ___/___/12