2018 VANA Industry Awards Night - Newsagent of the Year - Retail - Newsagents Self - Nomination Form

NOMINATION FORM - RETAIL

Question Title

* 1.
Nominee / Nominator Details

Contact Person

Company/Newsagency

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

DECLARATION

Question Title

* 2.
I warrant that the information submitted in this entry is true and correct.

Date / Time

Date

Question Title

* 3. Signed By