Online Nomination Form for Watch Your Mate Medal Program

Watch Your Mate Medal Program

Nominator's Details:

Full Name(Required)

Email(Required)

Nominator's Phone(Required)

Relations to Nominee(Required)

Nominee's Details

Name(Required)

Address(Required)

Email(Required)

Nominator's Contact Number(Required)

Nomination Story:

How has the nominee positively impacted their local community in regard to water safety?

Please share specific instances or stories that highlight the nominee's contributions?

How does the nominee embody the values and spirit of the Watch Your Mate program?

Media Consent:

The information provided may be used in media and social media, for the purpose of promoting the Watch Your Mate Medal Program.(Required)

I Agree

I confirm that I have obtained consent from the nominee to share their story and details for the purposes of media and social media promotion related to the Watch Your Mate Medal Program.(Required)

I Agree

Upload any relevant photos or videos that can be used in the program's media promotion

Max. file size: 50 MB.

Note that consent for media usage of these materials is also required.

I declare by that the information provided is true to the best of my knowledge.(Required)

I Agree