Nominations Seniors Local Achievement | Richie Williamson Member for Clarence

Richie
Williamson MP

Nominations close 1 March 2024

2024 NSW Seniors

Local Achievement Awards

Nomination Form

Nominee Details

Select an option

An Individual

An Organisation

Title and Full Name

Age

Position Title and Organisation (if Applicable)

Contact Phone Number

Address

Name to appear on Certificate (if different from above)

Nominees State Electorate

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Your Details

Title and Full Name

Contact Phone Number

Address

Reasons for your nomination

What is your relationship to the Nominee and or Organisation?

What achievements or contributions has the nominee made to their chosen field or the community?

Nominator Declaration

Click on each statement to declare

I declare, to the best of my knowledge, the information provided is true and correct

I have informed the individual or organisation of this nomination

Full Name

Date

Signature

Thank you!