LEETON SHIRE
AUSTRALIA DAY AWARDSÂ
NOMINATION FORM
DETAILS OF PERSON/ORGANISATION BEING NOMINATED:
Please review the award category guidelines
here
Name of Nominee
*
(required)
Postal Address
*
(required)
Contact Number
*
(required)
Email
*
(required)
Nominated Category
*
(required)
Citizen of the Year
Young Citizen of the Year
Achiever of the Year
Young Achiever of the Year
Event/Group/Organisation of the Year
Lifelong Citizen to the Shire
Sportsperson of the Year
Junior Sportsperson of the Year
Reason for Nomination
*
(required)
Do not assume the judges will know about your Nominee. Each application is scored by individual judges based on the information provided with each application.
Supporting Information/Evidence
(Maximum size: 500 KB )
Upload additional supporting information or evidence here. This may include letters of support, media articles, certificates etc.
YOUR DETAILS:
Name
*
(required)
Phone Number
*
(required)
Your Email
*
(required)
NOMINATIONS CLOSE FRIDAY 10 JANUARY 2020
F
or further enquiries please phone Hannah Fitzsimon on 6953 0956 or email hannahf@leeton.nsw.gov.au
Ignore