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Nomination Form


This is a general nomination form. Please contact your local representative if you require further information.
Personal Detalis
Name
Date of Birth / / (dd/mm/yyyy)
Postal address
Suburb

 
State
Postcode
Phone (Home)
Phone (Mobile)
Email

 
NEXT OF KIN  
Name

 
Phone (Home)

 
Phone (Mobile)

 


Employment Details
Employer
Company Address
Position

 
Phone (Work)

 
Fax Number (Work)
Email
Number of Defence Reservists working within your company (if known)

 
Name/Name of Reservists
if known

Reservist's unit/squadron
if known

 


Clothing Details
Required for issue of Protective Clothing.
Top size
Bottom size
Height (cms)
Weight (kgs)
Chest Measurement (cms)
Waist Measurement (cms)


Other Details
Insert preferred date/s if known
Any special dietary requirements
Any previous injury/illness that may affect you during the exercise
 
Still photographs and vision of nominees obtained during EES can be used in Defence Reserves promotional material, including Defence Reserves Support advertisements:
 Yes  No
 
   
Word icon If you prefer, here is a PDF version of the Nomination Form which you can download and fax/post back.