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This form is to be used to nominate a member of the Camden Community for their contributions to their community and its people during 2011. Please feel free to submit more than one nominee. The Awards will take place on Australia Day, 26 January 2012. Entries close 16 January 2012.
Please read the Conditions of Entry before completing the form below.
Citizen of the Year (Aged 21 or over as at 31 December 2011)Young Citizen of the Year (Aged under 21 as at 31 December 2011)Sportsperson of the Year (Aged 21 or over as at 31 December 2011)Young Sportsperson of the Year (Aged under 21 as at 31 December 2011)Community Event of the Year (must be an event within the Camden LGA during 2011)
Surname:
Given Name/s:
Postal Address:
Phone: (h) (w) (m)
(email)
Date of birth:
School: (If applicable)
Please ensure you fill in all details correctly. Submitting the wrong information may cause delays in judging or difficulty in contacting the nominee to inform them of their nomination. If you do not have the requested details please endeavour to obtain them before submitting the nomination form.
Club/Organisation:
Please list personal achievements, awards, degrees or community/sporting involvement.
Please provide a summary of community services and activities the nominee was involved with in 2009.
Other information you feel relevant and why you feel they should receive the Civic Award.
Please hit the submit button below to submit your form.
