Nomination Form for the New Zealand Rugby League

NOMINATION FORM FOR THE NEW ZEALAND RUGBY LEAGUE

LIFE MEMBERSHIP / DISTINGUISHED SERVICE AWARD

INFORMATION SHEET

This sheet outlines the process for nominating an individual for NZRL Life Membership or Distinguished Service Award.

Criteria for Life Membership Nomination

a)These are prestigious honours that are not awarded lightly nor earned as of right. They are awarded for long, well documented and meritorious service;

b)Recipients must have during their time, advanced or improved the game of Rugby League significantly, such that their contribution is widely recognised as outstanding;

c)Recipients should have introduced policies or initiatives that have made a significant impact either at national or District/Zonal level;

d)Recipients ideally should be life members at both Club and District/Zone level first before being considered at national level.

Criteria for Distinguished Service Award Nomination

a)The criteria for Distinguished Service Award Nomination are similar in spirit to Life Membership, but aimed at District/Zone service.

b)Recipients should have demonstrated an ability to impart knowledge or experience for the benefit of others at varying levels of the game.

Nomination Process

Please complete the attached form with relevant details on the individual. Include as much material as you can to give the Awards Committee a complete understanding of their involvement & contribution to the game.
If the nomination is coming from a Club or District League, please forward the form to your Zone for endorsement.

Under the NZRL Constitution, nominations may only come from Zones or Associates. This will require approval by the Zone Board.

The Associates are:

Masters of Rugby League New Zealand Inc.

New Zealand Maori Rugby League Inc.

New Zealand Rugby League Kiwi Association Inc.

New Zealand Universities & Tertiary Students Rugby League Council Inc.

New Zealand Women's Rugby League Inc.

NOMINATION FORM LIFE MEMBERSHIP/DISTINGUISHED SERVICE AWARD

Section 1: Nominee Name & Contact Details

Candidates Full Name:
Date of Birth:
Current Address:
Postcode:
Contact Phone Number:
Contact Mobile Number:
Contact Email Address:
Life Membership Award Distinguished Service Award

Section 2: Club Involvement

Has the nominee served at Club level? / Yes  No 
Is the nominee a Life Member of any Club(s)? / Yes  No 
Please provide summary of their Club involvement, excluding their playing record.

NOMINATION FORM LIFE MEMBERSHIP/DISTINGUISHED SERVICE AWARD

Section 3: District League/ZoneInvolvement

Has the nominee served at District level? / Yes  No 
Is the nominee a Life Member of any District(s)? / Yes  No 
Please provide summary of their District League involvement, excluding their playing record.

Section 4: National LevelInvolvement

Has the nominee served at New Zealand level? / Yes  No 
Please provide summary of their New Zealand involvement, excluding their playing record.

NOMINATION FORM LIFE MEMBERSHIP/DISTINGUISHED SERVICE AWARD

Section 5: Reason for Nomination

Please outline below what you consider to be the major components of their service which you consider outstanding. Please attach any relevant data / evidence which confirm the nominee’s outstanding service.

Section 6: Proposer Details

Proposers Full Name:
Proposers Organisation:
Contact Phone Number:
Contact Mobile Number:
Contact Email Address:
Signature:

Section 7: Zone / Associate Endorsement

Zone/Associate Name:
Contact Phone Number:
Contact Mobile Number:
Contact Email Address:
Chairperson Signature:

Thank you for taking the time to prepare this nomination.