PONY CLUB Australia Ltd 73-75 Mackie Road, Mulgrave 3170 National Chair: Carol Paterson P: 03 8685 8925 | E: [email protected]M: 0428 531 359 | P: 07 4653 1359 ABN: 95 090 080 265 National Secretary: Judy Pitt www.ponyclubaustralia.com.au M: 0428 593 591 | P: 03 6396 6191 Patron: Gillian Rolton Nominations close: 1 st May 2015 PCA Board Nomination Form Nominee Information Full name: .................................................... Postal address: ............................................... Phone(h): ..................... Phone(w): .................. Email: ........................................................ Nominee Declaration I understand that if I am elected to the PCA Board I will need to relinquish any position as; an employee of PCA, a Member State, Affiliated or Corporate Member or any Official Position with a Member State and that I am not a Director of PCA where clause 13.5.2 applies. Signature: .................................... Date: ...... Nominee Ratification Full name: .................................................... State: ........................ Position held: ............. Signature: .................................... Date: ...... Please ensure you complete the Nominee Experience & Knowledge Thank you for your nomination
Nominee DeclarationI understand that if I am elected to the PCA Board I will need to relinquish any position as; an employee of PCA, a Member State, Affiliated or Corporate Member or any Official Position with a Member State and that I am not a Director of PCA where clause 13.5.2 applies.
Please attach a passport size photograph (jpeg) and 250 word (word doc. format) statement about yourself and your experience to be included in voting information. All applications should be emailed to [email protected] and marked as Board Nomination.
