The state central committee shall enclose with the notice required by Section 7151 copies of the following form of proxy for attendance at the meeting of the state central committee:
PROXY FOR ATTENDANCE AT THE STATE CENTRAL COMMITTEE OF THE DEMOCRATIC PARTY MEETING AT _____, IN THE YEAR 19__
I, ____, duly qualified to sit as a member of the state central committee of the Democratic Party meeting at ____ in the year 19__ do hereby designate ____ (name); ____ (post office address); as my proxy with full power to act for me in every respect as a duly qualified member of the state central committee meeting at ____ on the ____ day of ____, 19__.
I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief.
Date ____ Place of execution _______
__________, Member