Town of Bassendean Community Awards Nomination

Award Category*

Sub-Category (for Active Citizenship Nomination only)*

Nominee

Name of Nominee (Individual or Organisation)*

Nominee Phone Number

Nominee Email

Please describe clearly and to the point what the nominee has done and why you think they should be recognised under the selected category.

Nomination Details*

Optional: Upload up to 3 supporting documents or images

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

Your Details

Name*

Email address*

Phone number*

Declaration

I am not the nominee, or a representative of the nominee
The nominee lives, operates, or is a business located in the Town of Bassendean
I understand the assessment of the nominee will be made based on the information that I have provided in this nomination
I understand that a copy of this nomination will be shared with the nominee
The information that I have provided is correct to the best of my knowledge

I agree with the above statements