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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