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11Questions
  • 1
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  • 2
    This is the name of the individual submitting the application
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  • 3
    Please note this is for the individual submitting the form.
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  • 4
    Please select the club that you are a member of. Please note this is for the individual submitting the form.
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    • Please Select
    • Albany Water Polo Association
    • B52's Water Polo Club
    • Bunbury Water Polo Association
    • Busselton Water Polo Association
    • Cockburn Water Polo Club
    • Demons Water Polo Club
    • Dolphins Water Polo Club
    • Geraldton Water Polo Association
    • Hedland Water Polo Association
    • Karratha Water Polo Association
    • Mandurah Water Polo Assocation
    • Melville Water Polo Club
    • New Wave Water Polo Club
    • Newman Breakers Water Polo Club
    • North Coast Water Polo Club
    • Peel Water Polo Club
    • Phantoms Water Polo Club
    • Rats Water Polo Club
    • Serpents Water Polo Club
    • Somerset Water Polo Club
    • Stirling Raiders Water Polo Club
    • Triton Water Polo Club
    • UWA Water Polo Club
    • Water Polo WA
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  • 5
    Please place the name of the individual you are nominating or alternatively, if you are nominating a Club, please place a name of a contact at the club.
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  • 6
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  • 7
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  • 8
    Please Select
    • Please Select
    • Albany Water Polo Association
    • B52's Water Polo Club
    • Bunbury Water Polo Association
    • Busselton Water Polo Association
    • Cockburn Water Polo Club
    • Demons Water Polo Club
    • Dolphins Water Polo Club
    • Geraldton Water Polo Association
    • Hedland Water Polo Association
    • Karratha Water Polo Association
    • Mandurah Water Polo Assocation
    • Melville Water Polo Club
    • New Wave Water Polo Club
    • Newman Breakers Water Polo Club
    • North Coast Water Polo Club
    • Peel Water Polo Club
    • Phantoms Water Polo Club
    • Rats Water Polo Club
    • Serpents Water Polo Club
    • Somerset Water Polo Club
    • Stirling Raiders Water Polo Club
    • Triton Water Polo Club
    • UWA Water Polo Club
    • Water Polo WA
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  • 9
    Please give short overview and tell us a bit more about your nominee.
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  • 10
    Please refer to the awards criteria
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  • 11
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