Application to Serve on the Committee – Wellington Figure Skating Club

Your full name *

Street Address

City

ZIP / Postal Code

Phone *

Email Address *

Date of birth *

Day *

Month *

Year *

Are you a member of WFSC *NoYes

Do you have any relevant professional qualifications? Please provide details.

Do you have any previous Committee experience? Please provide details.

Do you have any conflicts of interest that could affect your ability to serve on the Committee?

What involvement have you had with figure skating?

Eligibility

Under Section 3, Part 47 of the Incorporated Society’s Act 2022 every Committee Member must be a natural person, and must certify that they are not disqualified from being elected or appointed or otherwise holding office as an officer of the Club.

1. Are you an undischarged bankrupt? *NoYes

2. Are you disqualified from being a member of the Committee of a charitable entity under section 31(4)(b) of the Charities Act 2005? *NoYes

3. Are you prohibited from being a director or promoter of, or being concerned or taking part in the management of, an incorporated or unincorporated body under the Companies Act 1993, the Financial Markets Conduct Act 2013, or the Takeovers Act 1993? *NoYes

4. Have you been convicted of any of the following, and been sentenced for the offence, within the last 7 years: i. an offence under subpart 6 of Part 4 of the Incorporated Societies Act 2022, ii. a crime involving dishonesty (within the meaning of section 2(1) of the Crimes Act 1961), iii. tax evasion or a similar offence under section 143B of the Tax Administration Act 1994, iv. an offence under subpart 22 of Part 2 of the Incorporated Societies Act 2022, v. an offence, in a country other than New Zealand, that is substantially similar to an offence specified in sub-paragraphs (i.) to (iv.) above, vi. a money laundering offence or an offence relating to the financing of terrorism, whether in New Zealand or elsewhere, *NoYes

5. Are you: i. subject to a banning order under subpart 7 of Part 4 of the Incorporated Societies Act 2022; or ii. prohibited or restricted from acting as a creditor, lessor, transferee or buy-back promoter under section 108 of the Credit Contracts and Consumer Finance Act 2003; or iii. subject to a forfeiture order under the Criminal Proceeds (Recovery) Act 2009; or iv. subject to a property order made under the Protection of Personal and Property Rights Act 1988, or whose property is managed by a trustee corporation under section 32 of that Act? *NoYes

6. Are you subject to an order that is substantially similar to an order referred to in question 5 above under a law of a country, State, or territory outside New Zealand that is a country, State, or territory prescribed by the regulations? *NoYes

What are your reasons for seeking this appointment? *

Outline your skills, experience(s) and any specialised knowledge that supports the application for appointment to this Committee? *

Are there any improvements to the running of the Club that you would like to see? *

Please provide any additional information you feel is relevant to your application and attach your CV (optional).

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