Clone of Award Nomination: Open

Club Award Nomination Form

Life Membership
Nomination for Life Membership must be completed on this form for it to be considered by the Coogee Beach SLSC Board.

The following policy information is relevant to the selection criteria. Please read this information and address the appropriate areas in your nomination. Other supporting information may be attached.

Coogee Beach SLSC Constitution Clause 5.6 (d) A Member suitable for Life Membership is any natural person who has rendered distinguished service to the Association and Surf Life Saving, where such service is deemed to have assisted the advancement of the Association and Surf Life Saving in the City of Cockburn.

In additional to this, the following conditions, and criteria in the “Honours Policy” shall be used by the Honours Panel, Board and General Membership in the assessment of whether a nominee should be awarded with Life Membership:
1. The voluntary service rendered and the achievements during that period must be considered as distinguished.
2. Consistent, sustained, and dedicated service or achievement and exemplary contribution that is beyond what is expected of Association Members.
3. The service and achievement must primarily be for the benefit and/or advancement of the Association. Service and achievements within SLSWA or SLSA may also be considered as a contribution to the person’s nominations.
4. The contributions made by the nominee to the Association can be wide and varied and these must be considered. The number, types of positions, demands of each position and the period for which they were held should all be considered.
5. A competitive record including Local, State and/or National representation may also be considered as contributing to the nomination for Life Membership.
6. The nominee shall have shown to have abided by the Code of Conduct of SLSA, SLSWA and the Coogee Beach SLSC. The nominee must have exhibited professional, ethical, and positive conduct during their Membership of the Association.
Privacy:

These personal details are being collected by the Coogee Beach SLSC for the purpose of assessing the nominee’s eligibility for Life Membership of the Coogee Beach SLSC. The personal information will be disclosed to the Coogee Beach SLSC Honours Panel for the same purpose. These details will not be disclosed to any third parties by the Coogee Beach SLSC Board of Management and the Honours Panel. You have the right to access the information held about you by the Coogee Beach SLSC.
Nominee's Name:*
Nominated by:*

First NameLast Name
Nominator's Email:*
example@example.com
Nominator's Phone:*
Please enter a valid phone number.
Seconded by:*

First NameLast Name
Seconder's Email:*
example@example.com
Seconder's Phone:*
Please enter a valid phone number.
Supported by:*

First NameLast Name
Supporter's Email:*
example@example.com
Supporter's Phone:*
Please enter a valid phone number.
Supported by:*

First NameLast Name
Supporter's Email:*
example@example.com
Supporter's Phone:*
Please enter a valid phone number.
Supported by:*

First NameLast Name
Supporter's Email:*
example@example.com
Supporter's Phone:*
Please enter a valid phone number.
Please contact systems@cbslsc.com.au if you have issues with this form

Service, Membership and Awards
Summary of Distinguished Service:

In the space provided, please summarise the extraordinary nature of the nominee’s consistent, sustained, and dedicated service or achievement and exemplary contribution to the Coogee Beach SLSC and/or Surf Life Saving Western Australia. (Supporting information and detail to be shown in the following pages)
Summary of Extraordinary Service:*
Surf Life Saving Club Membership:*

Please contact the Lifesaving Administrator (lsadmin@cbslsc.com.au) to obtain a transcript of membership
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Nominee's Surf Life Saving Awards:*

Please contact the Lifesaving Administrator (lsadmin@cbslsc.com.au) to obtain a transcript of awards
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Nominee's Record of Service: Club
Please list the nominee's achievements/roles, with dates and details; add new rows as required*
How are these achievements distinguished and conspicuous?*

Nominee's Record of Service: State/National/International
Please list the nominee's achievements/roles, with dates and details; add new rows as required*
How are these achievements distinguished and conspicuous?*

Other Supporting Information

Optional
Other Awards: (Australian Honours, Civil, Sporting, Community)
Optional
Other Information
Optional
Other Attachments

Other supporting material that does not repeat the required information may be submitted here
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Should be Empty:

Club Award Nomination Form

Service, Membership and Awards

Nominee's Record of Service: Club

Nominee's Record of Service: State/National/International

Other Supporting Information