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International Women's Day Hall of Fame Nominations

Do you know a very special woman who is your unsung hero and deserves regional recognition? Please nominate her now!

As part of International Women Day 2012 and the Power of 100, Great Southern Women invite you to nominate an amazing Great Southern woman to be inducted into the inaugural Great Southern Women Hall of Fame.

We are hoping to attract nominees, ranging from high-profile businesswomen to neighbours caring for disabled children and ailing relatives and women who have changed history in the Great Southern of Western Australia.

Please use the form below to nominate a woman who has influenced you, it may be your mother, colleague, friend or neighbour.

Inductees will be announced at the Great Southern Women’s International Women’s Day function on Thursday 8th March.

Please complete ALL details on the form below and then press Forward Nomination.

Fields marked * are required; others are optional.

Nominee Details
First Name *
Last Name *
Title *
(e.g. pioneer, author, volunteer, scientist etc)
Daytime Phone
E-mail Address
Date of Birth
(dd/mm/yyyy)
Nominee's Current
Postal Address
Please Note: Nominees must be current residents of Western Australia
Submitter Details
Nomination Submitted
by*
Title / Occupation
Nominee's association
to the Submitter *
Submitter's Address
Submitter's Daytime Phone *
Submitter's Mobile *
Submitter's E-mail Address *
Reasons for Nomination
The 2012 WA Hall of Fame Inductees will be selected for distinction in one of the following five categories. In which category are you nominating this WA Woman?
Why are you nominating this West Australian woman in the above category for the WA Women’s Hall of Fame?
How do you believe your Nominee has contributed to her community, and/or to Western Australia, what do you believe her greatest achievements are?
What lasting impact has your Nominee's actions/dedication/achievements had in her local community, or to WA?
How do you believe your Nominee has helped foster, inspire, or encourage young/other West Australian women? Why is she a good role-model?

If you'd prefer to fill in a Microsoft Word version of the 2012 Nomination Form please click here. You can then complete the document and either email or print and fax or post it to us. Details are on the bottom of the Form.