Recognition of Service

The form below accompanies Council's Community Recognition Policy(PDF, 827KB).

Applications for recognition must be sent with at least 21 days notice prior to any celebration event (or 6 weeks for 100 year milestones)

Organisation Details

Name of Organisation

Address of Organisation

ABN or Incorporation No.

Contact Person Details (certificates will be mailed to this contact)

Name

Address

Phone Number

Email * (required)

Milestone for Recognition

Which milestone or achievement are you celebrating? (Please refer to Council's Community Recognition Policy - Organisations for information on what is available for each milestone)

25 years of operation

50 years of operation

75 years of operation

100 years of operation

Other Achievement (number of years in operation - see below)

Other Achievement - Provide a brief explanation (or please attach further information if needed)

How is your year of commencement determined? (ie. since incorporation)

Celebration Event

Date of EventDate of Event

Open the calendar popup.

Time of Event

Address where Event is to be held

Description of Event

Representation from the Mayor

If you are celebrating 25, 50, 75 or 100 years, would you like to request the attendance of the Mayor or his/her representative to present your plaque?

Yes

Tick to confirm declaration * (required)

I declare that the above information I have provided is true and correct

1 Dismissed Announcement

Extended hours at Burnie's Waste Management Centre

Recognition of Service