Person being nominated
Name
*
Enter the name of the peron being nominated
Person submitting the nomination
Name
*
Enter the name of the peron submitting the nomination
Organisation
*
VRLRA
NRL Vic
Altona Roosters
Casey Warriors
Doveton Steelers
Eastern Raptors
Frankston Raiders
Hume Eagles
Melton Broncos
Mernda Dragons
North West Wolves
Northern Thunder
Pakenham Eels
South Eastern Titans
Sunbury Tigers
Sunshine Cowboys
Truganina Rabbitohs
Waverley Panthers
Werribee Bears
Other
Other organisation
*
Enter organisation details
Email
*
Enter the email of the peron submitting the nomination
Mobile
*
Enter the mobile of the peron submitting the nomination
Criteria satisfied
Please explain the criteria satisfied for the nominated person
Criteria
*
10 years continued contribution to the development of VRLRA in an official capacity such as serving as a VRLRA Executive Committee member or coach/mentor
15 years service to VRLRA as either a referee, coach/mentor, or distinguished volunteer
A referee that represents the Victorian Rugby League with high distinction and pride, such as a referee that may have officiated grassroots Rugby League in Victoria and has progressed to have an outstanding career in the NRL.
Other
Criteria notes
*
Enter as much information as possible
Information /history of contribution
Please explain the contribution to Victorian Rugby League Referees Association that the nominated person has made.
Information:
*
Enter as much information as possible
Email
Enter the email address to receive a copy of the nomination
Submit
Should be Empty: