Port Pirie Regional Council is mindful of community concerns regarding the Coronavirus (COVID 19) and the impact it is having on our local community.

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Certificate of Merit Nomination Form

Required fields are marked with an asterisk (*).
Categories
Which category would you like to nominate
Nominee Details
Please insert the name of the person you would like to nominate
(Optional)
Date of Birth *
How has this person/organisation contributed to the community?
Additional Material may be attached if required
Nominator Details
Your Name
please insert your email address
Date of nomination *