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* 1. Please provide your name

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* 2. Please provide contact details for yourself (email or mobile)

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* 3. What is the name of the local organisation you'd like to nominate?

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* 4. Why are you nominating this organisation?

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* 5. Please provide contact details for your nominated organisation (Contact name, email, phone)

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* 6. Do you agree to the terms and conditions at http://www.thevillageuppermountgravatt.com.au/?

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