Australia Day Awards Nomination form

Cairns Regional Council's annual Australia Day Awards recognise citizens who have made a major contribution to the community. Use this form to submit your nomination for Council's 2013 Australia Day Awards online.  Nominations close Friday 30 November 2012.  Late nominations cannot be accepted.

Council is collecting your personal information for processing your nomination for the 2013 Australia Day Awards. The collection of this information is authorised under the Local Government Act 2009. See Council's Information Privacy statement. 
 

Australia Day Citizen Awards Nomination

* Fields are compulsory, other fields are optional.

Nominee's details


Business hours

After hours or mobile

Nominee's community contributions


for which the person is being nominated

and/or achievements

(Past & present) eg. community, sporting or professional bodies

Other referee


Business hours

After hours or mobile

Your details


Business hours

After hours or mobile

(if any)

Nominations must be submitted by Friday 30 November 2012. Contact at Council: