Upper Beaconsfield Community Centre Inc

Upper Beaconsfield Community Centre Inc.

10-12 Salisbury Road, Upper Beaconsfield 3808

ABN 86 016 259 616 Reg No. A000A5447

Telephone – 5944 3484 Facsimile – 5944 4179

Email -

Website – www.ubcc.org.au

NOMINATION FORM

I, (Full name of member proposing)

of (Address)

being a member of Upper Beaconsfield Community Centre Inc., hereby nominate:

(Full name of member being nominated)

to the position/s of:

Executive Committee member - voting positions

q  President (and RTO CEO)

q  Vice President ( 2 positions )

q  Secretary

q  Treasurer

q  Ordinary Committee member

on the Committee of Management of the Upper Beaconsfield Community Centre Inc.

or to a position on:

q  Crèche sub-committee

q  Toy Library sub-committee

(Signed by proposer) (Date)

I, (Full name of seconder)

of (Address)

being a member of Upper Beaconsfield Community Centre Inc., hereby second the above nomination

(Signed by seconder) (Date)

ACCEPTANCE OF NOMINATION

I, accept my nomination to a position on the Committee of Management of the Upper Beaconsfield Community Centre Inc. Being a current member of the association, I acknowledge that it is a legal requirement of the Department of Education & Training that I disclose in relation to the provision of courses under the Victorian Qualifications Authority Act 2000 the following:

Yes No

a.  Ever had their registration under section 23 of the Act suspended or cancelled.

b.  Ever had conditions imposed on their registration under section 23 of the Act.

c.  Ever been convicted of an indictable offence.

d.  Ever become bankrupt or taken the benefit of any law for the relief of bankrupt debtors,

or compounded with their creditors, or made an assignment of their property for their benefit.

e.  Ever been disqualified from managing corporations under part 2D.6 of the Corporations Act.

f.  Ever been involved in the provision of courses by another person or body who is covered by

paragraph (a) to (e) at the time of the events that gave rise to the relevant prosecution or other

action?

(Any queries regarding this disclosure or for further information please speak to the current President of the Committee of Management).

(Signed by nominee) (Date)