THE PCAWA CITIZENSHIP AWARD - NOMINATION FORM

NAME OF NOMINEE:
ADDRESS:
DOB: / DATE OF JOINING CLUB:
MEMBER OF PONY CLUB
NUMBER OF CLUB WORKING RALLIES ATTENDED IN CURRENT YEAR:

If Nominee has been a member of another Pony Club affiliated with the PCAWA, please state the name of Club, length of membership and reason for termination of Membership. A recommendation from the previous Chief Coach/Club President of that Club must be enclosed with this Nomination Form.

OTHER CLUBS I HAVE BEEN A MEMBER OF:
LENGTH OF MEMBERSHIP: / REASON FOR TERMINATION:
A Recommendation from previous Club Chief Coach/Club President is Enclosed:

DETAILS

The following Questionnaire is to be used as a guide when selecting a Nominee for the Citizenship Award:

  1. Has your nominee been a member of the Club for at least three years, and attended Rallies as regularly as circumstances permitted over a reasonably long period?
  1. Has he/she upheld the aims and objects of the Pony Club Movement?
  1. In what way has he/she been an outstanding member who has been helpful, etc?

(a)with the conduct and smooth running of the Club at Rallies

(b)at working bees

(c)with moving and erecting of equipment of Rally days

(d)in assisting, advising and encouraging other Pony Club members and generally helpful in all the functions of the Club

RECOMMENDATION BY PONY CLUB

COMPLETE IN DETAIL (attach additional sheet if insufficient room)

RECOMMENDATION FROM CLUB

(This Nomination form is to be signed by TWO of the following from the Pony Club)

SIGNED (Club Chief Coach)
SIGNED (Club President)
SIGNED (Club Secretary)
NAME OF PONY CLUB
Date of Meeting at which this
Recommendation was Passed

ENDORSEMENT OF ZONE

(This Nomination form is to be signed by TWO of the following from the Zone)

SIGNED (Zone President or Secretary)
SIGNED (Zone Coach Co-ordinator)
NAME OF ZONE
Date of Meeting at which this
Endorsement was approved

CLOSING DATE: 4th December 2015

PLEASE RETURN TO:

Executive Officer

Pony Club Association of Western Australia Inc

303 Cathedral Avenue

BRIGADOON WA 6069

H:\Executive Officer\Programs\Vetsearch\PCAWA Citizenship Award Application Form 2015.doc