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Nomination Form

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* 1. Name of Award Nominee

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* 2. Nominated by (your name)

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* 3. Your email address and phone number

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* 4. Does the nominee reside within the City of Karratha?

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* 5. Nominee has been a volunteer administrator or office bearer in a recognised sports club / association located within the City of Karratha?

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* 6. Years of continuous service to sport within the City of Karratha?

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* 7. Committee position / positions held?

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* 8. Name of Club / Association?

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* 9. Can you provide a signed letter of support from the club / association endorsing their nomination?

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