Online Form - Walk of Fame and Australia Day Awards Nomination

Please use this form to nominate for the 2023 Walk of Fame and Australia Day Awards.

Today's date *

What category is this nomination for? *

Citizen AwardYoung Citizen AwardSenior Citizen AwardVolunteer of the Year Award
Community Group or Event of the Year AwardWalk of Fame

If you selected Community Group or Event of the Year - please tick one option

GroupEvent

Nominee Details
Title

Full Name *

Group or Event Name
if applicable

Address

Street Address:

City:

State:

Post Code:

Country:

Phone *

Reason for Nomination
(include nominee's contribution to community life, past and present involvement in community groups) *

Has the nominee's contribution been recognised elsewhere? If so, please list *

Nominator's Details
Title

Full Name *

Address

Street Address:

City:

State:

Post Code:

Country:

Phone *

Details of second person supporting your nomination
Title

Full Name *

Address

Street Address:

City:

State:

Post Code:

Country:

Phone *

Email *

Please upload any supporting documents or attachments

Maximum size of ALL attachments is 976.56 MB