Life Membership

Nomination Form
Your Name *
Your Company *
Address *
City *
State
Email Address *
* Required detail
Life Membership Nomination
Life Member Nominee:
Please state the reasons why you believe your nomination should receive the Life Membership to the MX Association:
You may also upload a document supporting your nomination:
I have read the criteria for nomination as set out at www.mxassociation.com.au/lifemembers.htm Yes
I understand that the my Nomination will be considered by the Selection Panel. It is at their discretion for my Nominee to be presented at the AGM for voting by the Association Members: Yes