FV Life Membership Nomination Form

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PRIVACY STATEMENT

FV will only collect, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth). FV may use and/or disclose personal information collected from you in this form, or by virtue of checks or searches undertaken (including disclosure to FV’s officers, employees, professional advisors, and any person to whom by law FV must provide any such information), including for the purposes of the FV Life Membership nomination process. You may access and read FV’s current privacy policy here.

NOMINATION INFORMATION YOU WILL NEED

Before you get started you will need the name and contact details (mobile and email address) of the FV Director supporting your nomination so that we can make contact with them to confirm your nomination.

Please familiarise yourself with the FV Life Membership Policy and carefully consider whether the candidate you are nominating meets the selection criteria.

FV Life Membership Policy - updated March 2026.
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Candidate's Name* This field is required.Name of the individual you are nominating for Life Membership.
First Name
Last Name
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Candidate's Contact Number* This field is required.Please provide the mobile phone number of the individual you are nominating for Life Membership (enter your phone number if not known)..
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Candidate's Contact EmailPlease provide the email address of the individual you are nominating for Life Membership (enter your email address if not known).
example@example.com
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Candidate's Gender* This field is required.
Please Select
Please Select
Male
Female
Non-Binary
Other
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Candidate's Birth Date* This field is required.
Date
Day
Month
Year
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Candidate's Place of BirthPlease enter the town, city and country where the individual you are nominating for Life Membership was born.
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Relationship to CandidatePlease identify your relationship to the candidate you are nominating for Life Membership (i.e. club or association, a relative or someone you have worked with).
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Candidate's Previous AwardsTo assist with verifying the credentials of the candidate you are nominating for Life Membership, please list any previous awards or achievements in relation to performance or outstanding service to the sport of Football in Victoria.
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Large
Normal
Small
Ok
Ok
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Candidate Biography* This field is required.In 300 words or less, tell us why you believe the candidate you are nominating for Life Membership should receive the honour.
0/300
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Ok
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Name of Director Your Nomination* This field is required.Please select the name of the FV Director supporting your nomination.
Please Select
Please Select
Dr Angela Williams
Yianni Zaparas
Steve Forbes
Carolyn Jackson
Elpis Korosidis
Elenna Niteros
Darren Yates
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Nominator Contact Details* This field is required.
Full Name of Nominator
Position of Nominator
Mobile Number of Nominator
Email Address of Nominator
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PhotographsPlease upload any photographs of the individual you are nominating for Life Membership. A limit of 12 files is allowed with PNG, GIF or JPG/JPEG file types supported.
Drag and drop files here
Select files to upload
Max. file size: 24.3MB
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Supporting Documentation* This field is required.Please upload any documents or newspaper clippings supporting your nomination. A limit of 6 files is allowed with PDF or DOC/DOCX file types supported.
Drag and drop files here
Select files to upload
Max. file size: 12.6MB
Cancelof
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I declare and acknowledge that the information entered throughout this application is true and accurate as to the best of my knowledge.* This field is required.
Yes
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