Nominations are now opened for 2015 SLS WBC Branch Life Membership.

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1 Circular Title: 2015 SLSWBC Branch Life Membership nomination Document ID: Audience: Summary: Date: All Clubs, Branch Officers, Councillors and Life Members, Secretaries/Administrators, and Interested Parties Nominations are now opened for 2015 SLS WBC Branch Life Membership. 29 April 2015 Clubs and interested members are invited to nominate suitably qualified members for the Life Membership of the Branch. Nominations are to be on the appropriate form, completed in all details, and are to be lodged with the Administrator by Friday, 29 May Life Membership is the highest accolade that the Branch can award, so only members who have given exemplary service to the Branch should be considered. Nominations shall be referred to the Life Members & Civil Honours Panel for review and comment. The Club Presidents shall meet in camera or consult with the Executive Officers of their respective Clubs and endorse or reject each nomination. Yours in Life Saving Chris Donnelly Branch President Wide Bay Capricorn Branch

2 Nomination for Life Membership of Surf Life Saving Wide Bay Capricorn Please print clearly. Please attach additional information if space is not sufficient. Other supporting information may be attached. Include life memberships of club, branch and state, including dates on the respective page dealing with that body. Life membership is awarded to members who have rendered distinguished voluntary service to Surf Life Saving Wide Bay Capricorn for over a period of at least 10 years, within a period of 15 years. To be considered as distinguished service, the service must be both sustained, and provide a conspicuous contribution. Life Membership is awarded in accordance with SLSWBC Constitution, Section C, 2.1. Privacy These personal details are being collected by Surf Life Saving Wide Bay Capricorn for the purpose of assessing the nominee's eligibility for Life Membership of SLSWBC. The personal information will be disclosed to the SLS Wide Bay Capricorn Council for the same purpose. These details will not be disclosed to any third parties by Surf Life Saving Wide Bay Capricorn. You have the right to access the information held about you by Surf Life Saving Wide Bay Capricorn. This nomination for Life Membership of Surf Life Saving Wide Bay Capricorn is made on behalf: (Nominees Name) Proposer: Signature: (Name) Position: Date: Seconder: Signature: (Name) Position: Date: Nominee's personal details First Name Last Name Date of birth Male / Female (please circle) Address Town State Postcode Phone (H) Phone (W) Phone (M) Fax

3 Summary of distinguished service In the space below, please summarise the distinguished nature of the nominee's sustained and conspicuous contribution to Surf Life Saving Wide Bay Capricorn (supporting information and details to be shown in following pages). Surf Life Saving Club Membership Year joined Years of service Club From (year) To (year) Club From (year) To (year) Nominee's surf lifesaving awards number Date number Date number Date number Date number Date number Date

4 Nominee's record of service: club

5 Nominee's record of service: branch (if applicable) _ Nominee's record of service: state (if applicable) _

6 Nominee's record of service: national Nominee's record of service: international Other awards (Australian Honours, civil, sporting, community or other honours) Office use only Presented by (first name, surname) President of Wide Bay Capricorn Branch (President s signature) Life Membership and Honour Committee No Recommendation (circle relevant) Date Resolution of Affirmative Branch Council Negative (Circle relevant) Branch President Signature Date Surf Life Saving Wide Bay Capricorn t Level1, 62A Barolin Street f Bundaberg QLD 4670 w.slswbc.com.au PO Box 6170 ABN: Bundaberg East QLD 4670