Nomination Form

Make your nomination for
’Individual Making a Difference in the Community’ by completing the form below.

Once you have completed your nomination, click 'Submit Nomination'. After submitting your nomination, you will then have the option to start additional nominations.

Nominations close 16th September 2019.

  • Your Details

  • This is the title that will be used on the website and
    presentation on the night should you be shortlisted.
  • Your Nomination

    Judges will be looking to recognise dedication to volunteering efforts, organised fund-raising initiatives, supported individuals or communities through challenging situations, or /and giving back through various initiative: i.e.: community-based projects and / or services that have supported the regions communities.

  • Supporting Files

  • Accepted file types: jpg, png.
    (JPG or PNG, Max 2MB)
  • (Max 10MB)
  • (Max 10MB)
  • (Max 10MB)