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The Honourable Kevin Rudd MP

presents

14TH ANNUAL GRIFFITH
AUSTRALIA DAY AWARDS
Do you know someone who deserves recognition for making a valuable
contribution to our Southside community through their voluntary work?
The Griffith Australia Day Awards Committee is calling for nominations
for a Griffith Australia Day Award.
Criteria for nomination includes:
• Activities must be carried out on a voluntary basis; and
• Nominees should not have received an Australian or Commonwealth
Honour unless the field of endevour is different to the original honour.
For further information please contact the Office on (07) 3899 4031 or Griffith.EO@aph.gov.au

2013 GRIFFITH
AUSTRALIA DAY
AWARDS
NOMINATION FORM
Details of person being nominated:
Name: ____________________________________________________________________________
Address: ____________________________________________________ Postcode: ____________
Telephone: Daytime _________________________ After hours __________________________
Has the person been advised of their nomination?

Yes

No

Details of the nominating individual or organisation:
Name: _____________________________________________________________________________
Organisation (if applicable): __________________________________________________________

Address: ____________________________________________________ Postcode: _____________
Telephone: Daytime ________________________ After hours ___________________________

Please send completed nomination form to:
The Griffith Australia Day Awards Committee
C/- The Office of the Hon Kevin Rudd MP
PO Box 476
MORNINGSIDE QLD 4170

Closing date for nominations is Wednesday, 31 October, 2012

PLEASE COMPLETE NOMINATION DETAILS OVERLEAF

REASON FOR NOMINATION (200-250 WORDS):

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