Cover Nominations

Nomination Form

Thank you for taking the time to nominate a local who has made a contribution to the community, to feature on the White Pages and Yellow Pages under the cover theme "A helping hand, the Aussie way".

As a reminder, we are looking for people who have gone above and beyond to help others when times get tough. They are the people who reunite and rebuild our communities after times of crisis or challenge. They bring the community together for the common good, smile in the face of adversity and work hard to strengthen our regions in many different ways.

From the nominations we receive, the shortlisted nominees will be contacted by The PR Edge, who is assisting Sensis with the Covers Program, with the chosen person to appear on the cover of their local 2012/13 Yellow Pages and White Pages directory.

Three simple steps will complete your nomination:

Step 1 - Check closing dates by directory region to ensure nominations are still open

Step 2 - Review the selection criteria as outlined in the article www.whitepagescommunity.com.au/content/calling-all-aussies-lending-helpi...

Step 3 - Check that your nominee is happy for you to provide this information to us, and if so please complete the nominations form below.

Alternatively you can write to The PR Edge, Building 3, 658 Church St, Richmond VIC 3121 or fax 03 8416 6779

Nominations will be treated in strictest confidence and in accordance with the Sensis privacy statement available at www.about.sensis.com.au

Your details

Region for which you are nominating: *

Title: *

First Name: *

Last Name: *

Email address: *

Contact phone number: *

Nominee’s details

Title: *

First Name: *

Last Name: *

Town/Suburb: *

State: *

Email address (optional):

Contact phone number (optional):

To submit your nomination, in 200 words or less, describe how the nominee has made a positive impact in your community according to the theme criteria: *