FOOTBALL MARYBOROUGH
2010 STANDING COMMITTEE DELEGATE NOMINATION FORM

This Nomination is submitted by ________________ FOOTBALL CLUB INC
                                                                                 
We hereby make the following nominations for positions for 2010 within the FM CA

Ladies Delegate ___________________________ Signed _____________________
     

Mens Delegate ____________________________Signed _____________________

Juniors Delegate __________________________ Signed _____________________

Coaches Delegate__________________________ Signed _____________________

Nominations are to be handed in at the FM AGM on the 23rd November 2009.
Nominations are to be signed by the nominee.  If the nominee is not attending
this meeting,
you will need to forward this form to the FM Secretary, PO Box 206,
Maryborough 4650
by Monday the 09th day of November 2009.

A Chair of each Standing Committee will be appointed from the nominations
received from all FM Clubs. All delegates on the Standing Committees will be
required to attend meetings and be available at Federation Park during
corresponding matches.

____________________________________________________________________


Nominee Postal address:   _____________________________________________

___________________________________________________________________

 Email address: ______________________________________________________

 Phone (AH) _______________________Phone (BH):   _______________________

 Mobile: __________________________Fax: ____________________

I am willing to be so nominated ____________________ 
                                                          (Printed name)

                                                  ____________________ 
                                                     (Nominee signature)
                                                         

Dated:                /       /  

Club Delegate: _______________________________________________________

Position Held: ________________________________________________________

Postal address: _______________________________________________________

E-Mail address _________________________________ Fax: __________________

Phone (AH): ___________Phone (BH):______________  Mobile:________________

Delegate Signature ___________________________   Dated      /     /

Seconder:________________________

Seconder Signature ___________________________  Dated       /    /

A nomination must be lodged with the  Appointed Returning Officer

Appointed Returning Officer is: Joanne Downes, Secretary, 
PO Box 206, Maryborough 4650


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