A member of the Federation of Australian State and Territory Day Associations and the British and Commonwealth Societies Association. Patron in Chief: Sir James Gobbo AC CVO KStJ QC.

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Nomination Form

Please complete this online form to nominate an individual or organisation for the Victoria Day Awards.

(Alternatively, if you would prefer to download the form and fill it out, please download it here. Please print the page, complete the details and mail your nomination to the address on the form)

"*" indicates required fields

Step 1 of 4 - Award Category

25%

Victoria Day Award category (choose one)*

The Victoria Day Award for Community and Public Service.

The Victoria Day Award for Community and Public Service by a young Victorian

The Victoria Day Award for Community and Public Service by a Victorian Organisation or Association

The Victoria Day Award to a Good Corporate Citizen

The Victoria Day Award for the Arts

The Victoria Day Award for a Local Achiever

Your Name*

First Last

Your Email*

Your Phone*

Your Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Organisation Name*

Arts organisation name (if applicable)

Business Name*

Please select the contact methods you have for the nominee (must choose at least one)*

Phone

Postal address

Are you nominating a delegate on behalf on the organisation?*

Yes (delegate details will be required)

No (just the business/organisation)

Nominee's Name*

First Last

Nominee's Email*

Nominee's Phone*

Nominee's Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Please outline in approximately 500 words why your nominee might be appropriate to receive a Victoria Day Award.*

Attach supporting documents or images (optional)

Drop files here or

Accepted file types: docx, pdf, doc, txt, rtf, odt, png, mp3, jpg, bmp, ppt, pptx, pps, ogg, Max. file size: 128 MB.

Attach photo of the nominee (optional)

Drop files here or

Accepted file types: png, jpg, bmp, gif, wmf, pdf, webp, jpeg, jfif, tif, tiff, Max. file size: 128 MB.

Comments

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