Further enquiries, contact the Shire of Dumbleyung (08) 9863 4012 or ntaylor@dumbleyung.wa.gov.au

ENTRIES CLOSE 31ST OCTOBER

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* 1. Nomination category

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* 2. Nominee

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* 3. Reasons for nomination

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* 4. How has the nominee demonstrated active citizenship and enhancement of community life?

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* 5. How has the nominee's contribution been recognised elsewhere?

*Please email cdo@dumbelyung.wa.gov.au with any additional information that may support this nomination.

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* 6. Nominator (Your Name)

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* 7. The person I am nominating meets this selection and eligibility criteria:

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