TasCOSS Life Membership Nomination Form 1. TasCOSS Life Membership NomineePlease provide contact details of the individual you wish to nominate for TasCOSS Life Membership.1.1 Full Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title Given Name(s) Surname 1.2 Position/Job Title (if applicable)1.3 Organisation (if applicable)1.4 Email Address* Enter Email Confirm Email 1.5 Phone Number*2. TasCOSS Life Membership Nominating MemberPlease identify the TasCOSS Member responsible for the TasCOSS Life Membership nomination. NB: The nominating member must be a current member of TasCOSS.2.1 Full Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title Given Name(s) Surname 2.2 Position/Job Title (if applicable)2.3 Organisation (if applicable)2.4 Email Address* Enter Email Confirm Email 2.5 Phone Number*3. QuestionnaireLife Membership is awarded at the discretion of the TasCOSS Board for outstanding service and/or contribution to TasCOSS and the Tasmanian community service industry. A person who is made a Life Member by the Board shall be entitled to the same voting rights and privileges as a Designated Member, without the requirement to renew their Membership on an annual basis. Life Members will not be removed from the register of Members unless they serve a notice of resignation, or are expelled in accordance with Clause 30 of the Constitution. TasCOSS Life Membership Criteria: The Board shall only confer Life Membership on Members of the Tasmanian Council of Social Service Inc who satisfy one (1) or more of the following criteria: Have diligently and with distinction, served the Tasmanian Council of Social Service Inc as an employee1 or as a volunteer; and/or Have made a significant and noteworthy contribution to the Tasmanian Council of Social Service Inc by virtue of their tenure or achievements; and/or Have been a past Board President; and/or Have been a past Board Member with six-years of service. Notes: 1 Serving employees of the Tasmanian Council of Social Service Inc are ineligible for Life Membership.3.1 Has the nominee previously served as as the President and/or a Board Member of TasCOSS?* Yes No 3.1.1 How many terms did the nominee serve on the TasCOSS Board?* One-term (two years) Two-terms (four years) Three-terms (six years) 3.3 Please provide details of the key reason(s) for making the nomination for TasCOSS Life Membership.*[max. 250 words]3.4 Please provide details of the nominees service to TasCOSS and/or contribution to the Tasmanian community service industry.*[max. 250 words]4. Declaration & PrivacyElectronic Signature of Nominating Member*Date* Date Format: DD slash MM slash YYYY