Nomination Form

Please complete the following form to nominate someone for a 2019 Australia Day Award.

Whitsunday Regional Council is collecting the personal information you supply on this form for the purpose of processing this application. This information will only be accessed by authorised Council employees and judges. Your personal details will not be disclosed to any other personal or agency external to Council without your consent unless required or authorised by law.

By completing this form you are confirming you have read and understood the above privacy statement and agree to its conditions, and that all details contained in the nomination is true and correct.