Hockey Australia Life Membership Nomination

Hockey Australia Life Membership Nomination

Provide the nominee’s details, contributions, and supporting information for your Life Membership submission.
Purpose of Award

Life Membership recognises individuals who have demonstrated outstanding and sustained service to hockey at a national and/or international level. Their contributions must have significantly enhanced the growth, development, and sustainability of hockey in Australia.
Eligibility Criteria
To be eligible for nomination, the nominee must have:

• Demonstrated significant, sustained, and conspicuous contribution to hockey in Australia
• Contributed at a national and international level
• Completed a minimum of 15 years of service, which includes combined roles of National and International capacity (recommended benchmark; may be exceeded for stronger consideration).
• Undertaken contributions in an honorarium or volunteer capacity
• The general attitude and overall demeanour must reflect a dedication to the values of hockey in Australia.

Examples of contributions may include (but are not limited to):
• Service with Hockey Australia
• Involvement with international federations (e.g., FIH)
• Administration and governance
• Technical roles (coaching, officiating, umpiring)
• Facility or stadium development
• Strategic or program development

Exclusions
• A nominee’s playing career will not be a prime consideration but only an indication of involvement in our sport.
• Paid or contracted roles will not be considered as part of the assessment but only used as an indication of involvement in our sport.
Nominee Details
Family Name
Given Name(s)
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mobile Phone
Home Phone
Email
example@example.com
Date of Death (if applicable)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Contributions to Australian Hockey
National Contribution
Please outline the nominee’s outstanding achievements and contributions at a national level by listing roles, organisations, and years of service.
International Contribution
Please outline the nominee’s outstanding achievements and contributions at an international level by listing roles, organisations, and years of service.
Awards and Recognition
List any awards, honours, or formal recognition received.
Impact of Contributions
What has been the impact of the nominee’s service on hockey in Australia? (Consider growth, participation, governance, high performance, infrastructure, or international reputation)
Other Relevant Information
Include any additional information supporting this nomination
Volunteer Status Declaration: Were any of the roles described above paid or contracted positions?
If Yes, please provide details:
(Note: paid roles will not be considered in assessment)
Supporting Information
File Upload

Cancelof
Supporting documents attached?
Letters of support included (if applicable)?
Nominating Body Details

(State/Territory Association)
Name of Organisation
Contact Person

First NameLast Name
Position
Email
example@example.com
Phone
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Declaration
We confirm that this nomination has been endorsed by the relevant member association (State/Territory body) and that the information provided is accurate to the best of our knowledge.
Name

First NameLast Name
Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

Hockey Australia Life Membership Nomination

Purpose of Award

Nominee Details

Contributions to Australian Hockey

Supporting Information

Nominating Body Details

Declaration