Required fields are marked with an asterisk (*).

Nominee Details

Nominee name *

Nominee address *

Nominee phone *

First Nominator Details

First nominator name *

First nominator address *

First nominator phone *

First nominator email

First nominator name of organisation and position held *

Second Nominator Details

Second nominator name *

Second nominator address *

Second nominator phone *

Second nominator email

Second nominator name of organisation and position held *

Supporting Details

Please provide a high level overview of the nominee's voluntary work *

What is special about how the nominee does their work? *

Please tell us about the impact of the nominee's work in the Manawatū District *

Please attach testimonials (if from organisations on official letterhead)