2020 NSW Seniors Festival Local Achievement Awards Nominations Form

Nominee's Details

Name of the person you are nominating

Age

Home address

Telephone (daytime)

Postal address (if different from home address)

Name to appear on certificate, if different from above

Your Details

Name

Mobile

Home Address

State reasons why you have nominated this person

What is your relationship to the individual?

What achievements or contributions has the nominee made to their chosen field or the community? Word limit (250 words) *attach additional paper or references if required

By adding your initials you declare that: to the best of your knowledge, the information provided is true and correct and that you have informed the individual of this nomination

MARK SPEAKMAN

MP for Cronulla

2020 NSW Seniors Festival Local Achievement Awards Nominations Form

Mark Speakman

MP for Cronulla

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