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Civic Award Nomination Form

Nomination

Please clearly print or type the following details about the person you are nominating. You must ensure that all sections of this form are completed or we will be unable to consider your nominee.
PLEASE ENSURE THAT THE NAME OF THE PERSON YOU ARE NOMINATING IS SPELT CORRECTLY AND THAT YOU PROVIDE THEIR CORRECT CONTACT DETAILS.

Nominee

Categories of Community Service

Please indicate the category under which you believe the nominee qualifies. One or more may be selected:

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