SolarHub Home Grown Hero Award 2021

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* 1. Contact details of person nominated:

Name

Address

Address 2

City/Town

State/Province

Email Address

Phone Number

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* 2. Contact details of person nominating:

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 3. District Association or Club Affiliation:

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* 4. Please provide examples of how the person nominated has demonstrated an exemplary commitment to their community- examples may include community events, volunteering, program development and other examples of going above and beyond.

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* 5. Can you provide supporting documentation?

Yes

No

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* 6. If you answered 'Yes' to the previous question please provide examples below:

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

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* 7. Do you provide permission for Netball ACT to use information provided for the purposes of judging the 2020 SolarHub Home Grown Hero Award?

Yes

No