COACHES AND TECHNICAL ADVISORY PANEL
MEMBER NOMINATION FORM
Nominee’s full name:
Nominee’s postal address:
Nominee’s email address:
I satisfy at least one of the categories of
members of this Standing Committee:1
(STATE THE CATEGORY)
I agree to comply with the Football NSW
Rules and Regulations (including the ByLaws) and I undertake to be bound by the
Code of Conduct:2 (YES/NO)
Nominee’s signature:3
Date:
Eligible Nominator 1:4
Name of Authorised Representative of
Eligible Nominator (if applicable):
Eligible Nominator’s or Authorised
Representative’s email address (as
applicable):
Signature of Authorised Representative or
Eligible Nominator (as applicable):
Date:
Eligible Nominator 2: 5
Name of Authorised Representative of
Eligible Nominator (if applicable):
Eligible Nominator’s or Authorised
Representative’s email address (as
applicable):
Signature of Authorised Representative or
Eligible Nominator (as applicable):
Date:
1
Nominated Members of this Standing Committee must meet at least one of the following requirements:
 hold an “A” license, “B” license or “C” license for coaches (or equivalent) (Advanced Licence);
 hold a “goalkeeper” diploma (or equivalent); or
 hold a “junior” license, “youth” license or a “grassroots” licence (or equivalent).
2
Before signing this form, please carefully read the Football NSW Rules and Regulations (including the By-Laws) and the Code of Conduct,
which can be found on the Football NSW website under the section “Standing Committees”.
3
Please note that you can only serve on one (1) Standing Committee at a time. In addition, your nomination as a member of the Coaches
and Technical Advisory Panel is conditional upon the following:
o You satisfying at least one of the required categories of members for this Standing Committee;
o Two Eligible Nominators nominating you and both Eligible Members (or their Authorised Representatives) signing this form;
o You signing this form; and
o You lodging this form via email to standingcommittees@footballnsw.com.au by 10am on Monday 14 December 2015.
4
Eligible Nominators include Registered Participants, Association & Branch Zones, Clubs and Futsal Clubs & Centres (see the By-Laws).
5
See footnote 4 above.