The 2017 Victorian NAIDOC Awards Nomination Form
Email address
(NAIDOC Patron, NAIDOC Sportsperson and Mr & Miss NAIDOC) Closes June 12th 2017
Important Information
Before you complete this form, should you be awarded the NAIDOC Patron, Mr or Miss NAIDOC or Sportsperson it is a requirement that you attend the following events:

NAIDOC Patrons & Mr & Miss NAIDOC Awards Night – Friday 30 June (6:30pm -9:30pm), Korin Gamadji Institute, Richmond Football Club
NAIDOC Flag Raising Ceremony – Monday 3 July (8.30am-10:30am), Federation Square
NAIDOC Government Reception – Wednesday 5 July (5:30pm -7:00pm), Goverment House
ACES Elder’s Breakfast – Thursday 6 July (7:30 am -9:30am), ASES Brunswick
NAIDOC March & Concert – Friday 7 July (10:30am- 12:00), Victorian Aboriginal Health Services (Fitzroy) and Federation Square (Melbourne)
NAIDOC Ball – Saturday 8 July (5.30pm-11:30pm), The Melbourne Pavilion, Kensington

Nominator Details
If you are nominating a person for Mr NAIDOC, Miss NAIDOC or NAIDOC Patron, you must have their permission to do so.
Nominator Name
Your answer
Nominator Daytime Contact Number
Your answer
For which award are you nominating?
Nominee's Details
Nominee's Name
Your answer
Nominee's Daytime Contact Number
Your answer
Nominee's Email
Your answer
Nominee's Address
Your answer
Is the Nominee from Victoria? If not, where from?
Who is the Nominee's Mob? (If known)
Your answer
Tell us a little about the Nominee
Your answer
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