The undersigned, being a shareholder of [CORPORATION'S NAME], a [STATE] corporation, hereby waives notice of the date, time, place, and purpose of the special meeting of the shareholders of the corporation which (is to be)(was) held at [DATE], [TIME], and [PLACE]. The undersigned hereby consents to the shareholders of the corporation conducting such business as (may)(has) come before the shareholders at that meeting.

Date:

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