COMMITTEE NOMINATION FORM

First name

Last name

Phone

Current involvement with the Club (e.g. player, parent/guardian, coach, team manager, volunteer or other member)

In a short statement, please outline your reasons for nominating for this position, relevant experience or skills, and how you would contribute to the Club and its objectives.

I declare that:

I am a member of Canberra City Stallions Basketball Club.
I am not an undischarged bankrupt or insolvent under administration without leave of the ACT Supreme Court.
I have not been convicted of an indictable offence involving fraud, dishonesty or physical violence within the past five years.
I am not currently subject to an active disciplinary penalty or suspension issued by the Club.
I am committed to the Club's Objects, governance policies and community values.

Acknowledgements

I consent to being nominated for election to the Committee.
I understand that my nomination may be reviewed in accordance with clauses 8.4 and 8.5 of the Club Constitution.
I agree to comply with the Club's Code of Conduct and policies if elected and to sign a written declaration to that effect if requested by the Club.

Nominee's signature

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CANBERRA CITY STALLIONS

COMMITTEE NOMINATION FORM