First name
Last name
Email
Mobile
1.
How do you know the individual you are nominating?
2.
Nominee First Name
3.
Nominee Last Name
4.
Which category best describes the nominee? (Please select all that apply)
Not-for-profit/Community
Business/Retail
Education/Research
Health
The Arts
Tourism/Hospitality
Sport
Government
Agriculture
Other
5.
If Other, please advise:
6.
How are they involved in our community?
7.
What particular skills/attributes/experience do they have?
8.
Is there any other information you'd like to add?