Soldier On National Ski Camp, Comox, British Columbia, Canada 28 January – 3 February, 2018 Nomination Form

Please return completed nomination form to [email protected] by 5pm, Monday 27 November, 2017.

Full Name Date of Birth Email Address Contact Telephone Number Postal Address Service Number Year of Enlistment Year of Discharge

Service Army Navy RAAF Other (please list)

Operational service Yes No

Are you a member of the RSL (please note membership is not a requirement for selection) Yes No If yes which Sub Branch are you a member of: You must have a permanent physical and / or mental health injury / illness to be eligible to nominate. Please provide a summary of your condition/s.

What are some of the activities you have undertaken so far, or intend to undertake in the future, to aid your rehabilitation, recovery, and reintegration?

How would this camp contribute to your recovery, rehabilitation and reintegration? What outcomes would you hope to achieve by participating in the camp?

Please indicate any snow sports experience (snow sports experience not required to nominate) Never Beginner Intermediate Advanced Skiing Cross Country Skiing Snowboarding

Have you been involved in a similar activity in the past, eg Invictus? If so, briefly list details.

Is there any other information you wish to provide in support of your nomination?

I have attached a letter/s of support from my health professional/s confirming by ability to travel to and from Canada, and participate in these activities.

By ticking this box, I confirm that I have provided full and honest answers and disclosures within this nomination form and agree to the nomination and selection conditions.

NOMINATION AND SELECTION CONDITIONS

I fully accept and acknowledge that;  Selection will be determined by a panel which will comprise RSL, and health professionals.  The panel will make a decision on who they feel will benefit most from participation.  The decision of that panel is final. No further correspondence will be entered into.  I am of good character and standing with no outstanding civilian or military charges in progress.  Training will occur IAW MELs and be fully adaptive in nature. Due to busy activity schedule, applicants must have a limited requirement for rest throughout the day.  Participants will be joined with other ill/injured members and civilians, and therefore should be able to function in a social environment.  Meals and accommodations for this event may be located at Canadian Armed Forces bases/facilities, and thus they may be exposed to a day-today military environment.  There will be no alcohol allowed in the accommodations.  Participants may be required to share accommodations.  Participants will require a valid passport in time to travel.  Participants will be required to fly on dates determined by RSL Victoria.