Online Form - COPY - Nomination Form - Equine Advisory Group, Racing Industry Representative

To submit an online nomination for the Racing Industry Representative position on the Shire of Serpentine Jarrahdale's Equine Advisory Group, please fill out the form below.

Full name *

Street address *

Suburb *

Email *

Phone number *

Please provide brief details of any qualifications, skills, interest or experience you have that is relevant to the Equine Advisory Group. *

What has drawn you to nominate for the Equine Advisory Group? *

Please detail your involvement in any Council/Community Organisations/Groups or Committees, including the name of the organisation, your role and the dates of your involvement.

Are there any general comments you would like to make in support of your nomination?

Please provide the contact details of a referee who can support your nomination. *

I have read the Equine Advisory Group Terms of Reference *

Yes