ACT Champions Awards nomination form

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ACT Champions Awards 2008 – Nomination Form
 

Your details:


Name:


Address:


Postcode:


Telephone:


Email:


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Date of birth (if under 18):


If you are under 18 please ask your parent's or guardian's permission before providing your personal information.

My nomination (please tick):

Best Individual

Best Team

Best Organisation


Nominee details:

I’d like to nominate:
(full name of person, team or organisation)

Name:


Job Title (if individual):


Team name (if team nomination):


Organisation/place of work:


Address:


Postcode:


Telephone:


Email:


I would like to nominate them because:
(please provide as much information as possible)


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