Test Form – Queenscliff Surf Life Saving Club

Club Honour Award Nominations 2023-4

"*" indicates required fields

Nominee Name*

This is the person you wish to nominate for Club Honour.

Queenscliff SLSC Honour Awards*

Distinguished Service

Life Membership

Proposer Name*

First Last

Proposer Position*

Proposer Mobile*

Proposer Email*

Seconder Name*

First Last

Seconder Position*

Seconder Mobile*

Seconder Email*

Nominees Personal Details

Name*

First Last

Address*

Street Address City State Post Code

Email*

Phone*

Nominee’s Queenscliff Club Membership

Year joined QSLSC:*

Years of service:*

Other Club

Please list any other club and years of service

Nominee’s Surf Life Saving Awards and Club Roles

Please upload Nominee’s Surf Life Saving Awards and Club Roles

Please attach Nominee’s SurfGuard Award List and ‘Career’ Lifesaving Patrol Hours from SurfGuard (if applicable) You can find this via Members Area/SurfGuard – Member Links / Patrols / Lifesaving Patrol Hours / Career /Leadership positions eg Board Position, Patrol Captain, Competition leader

Max. file size: 8 MB.

Nominee’s record of service*

Please include Achievements/Role - From - To -Details

How are the achievements distinguished/sustained/conspicuous?*

Other awards (Australian Honours, civil, sporting, community, or other honours)

Nominees Record of Service – Branch, State and National

Club Honour Award Nominations 2023-4

Nominees Personal Details

Nominee’s Queenscliff Club Membership

Nominee’s Surf Life Saving Awards and Club Roles

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