Covid Crushers Nomination Form

Your Details

First Name

Last Name

Email Address

Your Role

Who are you nominating?

Tell us who and why you believe this person deserves to be recognized as a Covid Crusher.

Nominee's First Name

Nominee's Last Name

Nominee's Email Address

Confirm email

Nominee's Role

Nominee's Picture

Do you have a picture of your nominee? Include it here and it will be displayed along with your message.

Choose file

This recognition will be publically displayed on our website and social media channels. Please confirm if you have notified your nominee.

Yes, I have notified them.

No, I have not notified them.

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.