2018 VANA Industry Awards Night - Newsagent of the Year - Retail - Industry Partners Nomination Form

NOMINATION FORM - RETAIL

Question Title

* 1. Nominator Details

Name

Company

Email Address

Phone Number

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* 2.
Nominee Details

Contact Person

Company/Newsagency

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

DECLARATION

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* 3.
I warrant that the information submitted in this entry is true and correct.

Date / Time

Date

Question Title

* 4. Signed By