QRS Honorary Member - Nomination Form

Please complete ALL details listed with * in the form below and submit this to the QRS Committee. After your submission has been acknowledged you will be advised in due course regarding the outcome of your submission by email. This may take a short time for the committee to deliberate.

Should you have any questions in the meantime, please contact the forum admin via the contact form on the home page.

Your Name

Your Email

Mobile

QRS Membership Number

Membership Expiry Date

Date of Birth

Title

Christan Name of Proponant

Surname of Proponant

Grounds for Nomination

After processing the QRS committee may contact for additional information. Please allow 6 to 8 weeks for deliberation of the nomination. You will be advised of the outcome of your nomination by email to the specified email address.

All nominations will be treated as confidential by the QRS committee until the time of announcemnt at the netx AGM.

Thank you for your nomination.