Nomination Form | Love My Kwinana

1.

Do you want to nominate someone in a specific category?

If you leave this blank the panel will decide which category the person best fits into.

Kwinana Person of the Year

Kwinana Senior Person of the Year (over 60 years of age)

Kwinana Aboriginal Person or Group of the Year

Kwinana Group of the Year

2.

Nominee's/Group Contact Phone Number

* required

Maximum 255 characters

0/255

3.

Nominee/Group Address

Maximum 255 characters

0/255

If this nomination is for Group of the Year, please list the groups regular meeting place.

4.

Nominee/Group Email Address

* required

Maximum 255 characters

0/255

5.

Details of Nomination;

This is the section where you can provide us with details about the outstanding contributions and achievements the person or group you are nominating is making in our community.

This information is used to help our judging panel make their decision on the winners. The more information you provide in this section, the better chance the person will have of winning

* required

6.

What has specifically been achieved in the last 12 months?

7.

Photo (if desired)

8.