wlb nomination form

Waitematā Local Board Good Citizens’ Awards 2015

I would like to nominate (please print clearly):

Individual Children and Young People Community Group (please provide main contact)

Title: First name: Last name:

Phone: Mobile: Email:

Postal address:

Postcode:

Please provide details and examples of why your nominee deserves to be recognised for their work and why that work

helps makes Waitematā a better place to live. (Feel free to write on the back of this form if more space is required):

As nominator, I have checked that the spelling of the nominee’s name/names is correct and the contact details are current.

Your details:

Title: First name: Last name:

Phone: Email:

Postal address:

Postcode:

You may be contacted to discuss this nomination further.

Waitematā Local Board is calling for nominations for the bi-annual Good Citizens’ Awards, which will celebrate individuals and groups whose voluntary efforts make the Waitematā area a great place to live.

There are three award categories:

• Individual Award

• Children and Young People Award (24 years and under)

• Community Group Award

Successful nominees will be recognised at the Waitematā Local Board Good Citizens’ Awards ceremony, held at Auckland Town Hall on Wednesday 17 June.

Nominations must be received by the Waitematā Local Board by 5pm, Wednesday 20 May 2015.

For more information including the awards criteria and online nomination forms: aucklandcouncil.govt.nz/waitemata

facebook.com/waitemata

Waitematā Local Board office

35 Graham Street, Level 2, Auckland Central

waitematalocalboard@aucklandcouncil.govt.nz

09 353 9654

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