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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 your Community Hero?

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* 4. Why are you nominating this person as a Community Hero?

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* 5. Please provide contact details for your Community Hero (email or mobile)

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

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