Online Nomination Form

What position would you like ot nominate for:

Compulsory field

Please enter your name:


First name:

Last name:

Compulsory field

Please enter your email address:

Compulsory field

Please enter your phone number:

Compulsory field

Are you a member?

Yes - Ordinary Member
Yes - Associate Member
Yes - Life Member
I am a member of a Club
I don't know
Compulsory field

Please provide a copy of:

Your Resume: (a summary of relevant life saving experience)

Cover Letter: (please detail how you will succeed in the role)

Maximum size 2MB. Preferred filetype is 'pdf'.
Compulsory field

Please enter any messages (etc):

Privacy Notice
We respect your privacy. Information collected on this form will be used for the purpose of dealing with the nomination. This information may be disclosed to relevant staff, officers, members, suppliers, contractors, affiliates and/or training partners. If your nomination involves a person or a response from a person, that person may view the information you have provided in order to respond. Please contact us if you do not agree with our privacy policy as we may not be able to process your nomination. You will be able to access this information by contacting our Privacy Officer.

Note: certain information from your computer (including your IP address and other identifiers) will be collected when this form is submitted.

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