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Australia Day Celebrations

Australia Day Nomination Form

* Mandatory Field

Select which category you are nominating this person for
Select category*
The person you are nominating
Title*
First Name*
Last Name*
Gender*
Organisation/Position
Line 1
Line 2
Locality/Suburb
State
Postcode
Preferred Phone Number*
-
Email
Age*
DOB (if know)
(dd/mm/yyyy)
Aboriginal or Torres Strait Islander*
Australian Citizen*
Tell us why you are nominating this person
Keep in mind how they contribute to the community locally nationally or globally how they are an inspirational role model and how they demonstrate excellence in their field
In 500 words or less*
Additional Details
Additional Details
Your Title*
Your First Name*
Your Last Name*
Your Gender*
Line 1
Line 2
Locality/Suburb
State
Postcode
Your Preferred Phone Number*
-
Your Email
Your Age*
Are you Aboriginal or Torres Strait Islander*
Is the person you are nominating:*
How did you hear about the awards?*
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City of Whyalla
PO Box 126
Civic Building, Darling Tce
Whyalla SA 5600
Tel: (08) 8640-3444
Fax: (08) 8645-0155