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NOMINATION FORM FOR THE NEW ZEALAND RUGBY LEAGUE
LIFE MEMBERSHIP / DISTINGUISHED SERVICE AWARD
INFORMATION SHEET
This sheet outlines the process for nominating an individual for NZRL Life Membership or
Distinguished Service Award.
Criteria for Life Membership Nomination
a) These are prestigious honours that are not awarded lightly nor earned as of right. They
are awarded for long, well documented and meritorious service;
b) Recipients must have during their time, advanced or improved the game of Rugby
League significantly, such that their contribution is widely recognised as outstanding;
c) Recipients should have introduced policies or initiatives that have made a significant
impact either at national or District/Zonal level;
d) Recipients ideally should be life members at both Club and District/Zone level first
before being considered at national level.
Criteria for Distinguished Service Award Nomination
a) The criteria for Distinguished Service Award Nomination are similar in spirit to Life
Membership, but aimed at District/Zone service.
b) Recipients should have demonstrated an ability to impart knowledge or experience for
the benefit of others at varying levels of the game.
Nomination Process
1. Please complete the attached form with relevant details on the individual. Include as
much material as you can to give the Awards Committee a complete understanding of
their involvement & contribution to the game.
2. If the nomination is coming from a Club or District League, please forward the form to
your Zone for endorsement.
Under the NZRL Constitution, nominations may only come from Zones or Associates.
This will require approval by the Zone Board.
3. The Associates are:
Masters of Rugby League New Zealand Inc.
New Zealand Maori Rugby League Inc.
New Zealand Rugby League Kiwi Association Inc.
New Zealand Universities & Tertiary Students Rugby League Council Inc.
New Zealand Women's Rugby League Inc.
New Zealand Defence Forces Rugby League
4. Zone Contact Details:
Rugby League Northland
Alex Smits, General Manager
Ph: (09) 437 9640
Em: [email protected]
Akarana Rugby League
Evelyn Brooker, Community Development
Ph: (09) 526 0797
Em: [email protected]
Counties Manukau Rugby League
Kasey King, General Manager
Ph: (09) 571 3865
Em: [email protected]
Upper Central Rugby League
Sash Stosic, General Manager
Ph: (07) 578 0016
Em: [email protected]
Mid-Central Rugby League
Lisa Reweti, Acting General Manager
Ph: (06) 357 5349
Em: [email protected]
Wellington Rugby League
Jason Hemson, General Manager
Ph: (04) 560 0361
Em: [email protected]
Southern Rugby League
Steve Martin, General Manager
Ph: (03) 474 6425
Em: [email protected]
Nominations close March 31.
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NOMINATION FORM LIFE MEMBERSHIP / DISTINGUISHED SERVICE AWARD
Section 1: Nominee Name & Contact Details
Candidates Full Name:
Date of Birth:
Current Address:
Postcode:
Contact Phone Number:
Contact Mobile Number:
Contact Email Address:


Life Membership Award
Distinguished Service Award
Section 2: Club Involvement
Has the nominee served at Club level?
Yes

No

Is the nominee a Life Member of any Club(s)?
Yes

No

Please provide summary of their Club involvement, excluding their playing record.
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NOMINATION FORM LIFE MEMBERSHIP / DISTINGUISHED SERVICE AWARD
Section 3: District League/Zone Involvement
Has the nominee served at District level?
Yes

No

Is the nominee a Life Member of any District(s)?
Yes

No

Please provide summary of their District League involvement, excluding their playing
record.
Section 4: National Level Involvement
Has the nominee served at New Zealand level?
Yes

No

Please provide summary of their New Zealand involvement, excluding their playing record.
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NOMINATION FORM LIFE MEMBERSHIP / DISTINGUISHED SERVICE AWARD
Section 5: Reason for Nomination
Please outline below what you consider to be the major components of their service which
you consider outstanding. Please attach any relevant data / evidence which confirm the
nominee’s outstanding service.
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Section 6: Proposer Details
Proposers Full Name:
Proposers Organisation:
Contact Phone Number:
Contact Mobile Number:
Contact Email Address:
Signature:
Section 7: Zone / Associate Endorsement
Zone/Associate Name:
Contact Phone Number:
Contact Mobile Number:
Contact Email Address:
Chairperson Signature:
Thank you for taking the time to prepare this nomination.
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