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Walk of Fame Nominations

Please complete the application form below for your nomination to be considered for the City of Kalgoorlie-Boulder's Walk of Fame.

Today's Date*

Nominator Name

Nominator Phone Number*

Nominator Email Address*

Nominator Address

Name of Nominee, including any pre or post nominals*

Does this person still reside, or did they reside, in the region now known as the City of Kalgoorlie-Boulder?*

YesNo

Is the nominee deceased?*

YesNo

If yes, contact details for known living relatives

How long has/did the person reside in the region now known as the City of Kalgoorlie-Boulder?*

Why are you nominating this person for the Walk of Fame?*

How has the nominee contributed to the region now known as the City of Kalgoorlie-Boulder?*

What lasting impact has the nominee had on the people, community and region now known as the City of Kalgoorlie-Boulder?*

To your knowledge, has the nominee been recognised with commendations or awards for their achievements? If yes, what did they achieve?

Please upload any supporting documents or attachments

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

By ticking this box and submitting this application, you declare that the information provided is, to the best of the nominator’s knowledge, true and correct.*

Yes