Pillars of Bathurst Nomination Form

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Section 1 - Applicant Details

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4

Section 2 - Person being nominated

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dd/mm/yyyy
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Section 3 - Road naming database

Options are limited to 1
The decision whether or not to allocate the name to a road is dependent on a number of factors such as whether it has already been used or is too similar to a name already used.

Section 4 - The nominee's story (maximum 150-200 words)

Options are limited to 1

Section 5 - Photograph

Options are limited to 1
Options are limited to 1

Section 6 - Authorisation

Options are limited to 1