Hall Management Committee Nomination Form

Which Committee are you applying for?*

Nominee's Name*

First Last

Nominee's Address*

Street Address Address Line 2 City ZIP / Postal Code

Nominee's Contact Number*

Nominee's Email*

Organisation representing*

If applicable - if you are not representing an organisation, please enter Not Applicable

Nominee's statement*

Please give us a brief background about you and why you would like to be on this committee.

Privacy Statement*

Completion of this form may require the disclosure of personal information. The intended recipients of this information are officers of the Kingborough Council in order to advance the purposes of this form and to carry out Council business. The Personal Information Protection Act 2004 and Council’s Privacy Policy regulate the use of this information, which will not be disclosed to any other party, except with your permission or if required or authorised by law. You may make application to access or amend personal information held by Council by contacting the Customer Service Unit on (03) 6211 8200. Should you not provide the information sought, Council will not be able to process this form.

I have read and understood the privacy statement

Hall Management Committee Nomination Form

Hall Committee Nomination Form

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