Online Form - Australia Day Awards Nomination

Nomination Category *

CITIZEN OF THE YEAR
SENIOR CITIZEN OF THE YEAR
YOUTH CITIZEN OF THE YEAR
COMMUNITY GROUP OF THE YEAR

PERSON NOMINATED FOR AWARD:

Name *

Email *

Phone *

Address

Age (Youth Award Only)

Australian Citizen *

YesNo

Reason for Nomination *

Nominator Details:

Name *

Email *

Phone *

Address

Completed forms must be received by 4:00pm 20 december 2019 and are to be:

Emailed using the submit button below.
Lodged at our customer service counter – Monday to Friday (excluding public holidays).
Forwarded by post to Shire of Boddington, PO box 4, Boddington WA 6390.

Type the code from the image