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Nomination form
“We are Queenslanders – we’re the people they breed tough north of the border. We’re the ones that they knock down
and we get up again. This weather may break our hearts, but it will not break our will.” Anna Bligh, Premier of Queensland (January 2011)
www.queenslandweek.qld.gov.au

Message from the Premier of Queensland
I want to say a personal, heartfelt thank you to everyone who
has assisted in the recovery and rebuilding efforts following
the devastating effects of the 2010–11 Queensland floods and
Tropical Cyclone Yasi. Your response has been overwhelming.
The scars are going to take a long time to heal for many of us
and the road to recovery will be a long one. But while these
disasters broke our hearts they did not break our will. Stories
of the amazing Queensland spirit have emerged. We have seen
a ‘mud army’ of volunteers taking to the streets and countless
stories of bravery and self-sacrifice.
We have learned that Queenslanders are ready to pull together, ready to fight for each other,
ready to help their neighbour and sometimes ready to risk their lives to save others. In 2011,
Queensland Week will be held from 4–13 June and will be dedicated to recognising the
community heroes of these extreme and devastating weather events.
This program will recognise individuals who have shown outstanding community initiative,
bravery, courage, resilience and strength during the greatest natural disasters of our history.
I also want to sincerely thank all the police, emergency services and Australian Defence
Force personnel. Each one of these workers has shown immense courage and spirit
during Queensland’s darkest hour. They too will be honoured through their own official
recognition ceremonies.
Nominations close on Friday 1 April 2011 and I encourage you to put pen to paper and
nominate someone in your community whose heroism has inspired you.
Each nominee will receive a commemorative medal and will be publicly recognised for their
hard work, at local events in each of the affected regions during Queensland Week.
I look forward to sharing this very special Queensland Week with our disaster heroes.
ANNA BLIGH MP
PREMIER OF QUEENSLAND

Official nomination form
Heroes are those people who have shown outstanding community
initiative, bravery, courage, resilience and strength during the
2010–11 Queensland floods and/or Tropical Cyclone Yasi.
Entries close Friday 1 April 2011. The heroes will be announced
publicly during Queensland Week (4–13 June 2011).
Nominee’s details (the person you wish to nominate)
If possible, please send an image of your local hero with their
name by email to heroes@premiers.qld.gov.au. The image will not
be used for any purpose without the individual’s permission.
Nominator (your details)
Name:
Position/organisation (if applicable):
Address:
Name:
Position/organisation (if applicable):
Suburb:
State:
Address:
Postcode:
Email:
Contact phone number:
Suburb:
Postcode:
Contact phone number:
Email:
Reason for nomination (100 words)
State:
Relationship to nominee:
How did you find out about the Queensland Disaster Heroes
program? Please specify:
Nominator declaration
I hereby declare that I have submitted the nomination in accordance
with the Queensland Disaster Heroes conditions for nomination
and confirm that, to the best of my knowledge, the information
I have provided in this nomination is accurate, factual, complete
and up-to-date. I agree that the State of Queensland may use
and disclose my personal information in the manner set out
in the Queensland Disaster Heroes conditions for nomination.
Signature
Date
Endorsement
This nomination has been endorsed by
Name
Position
Organisation
Please nominate the region where the nominee demonstrated
heroic behaviour.
Cairns and Cassowary Coast
Rockhampton / Theodore
Bundaberg / Gympie
Toowoomba / Western Downs
Brisbane
Townsville
Emerald
Lockyer Valley
Ipswich
Signature
Nominations must be endorsed by a local councillor, state or federal MP, emergency
services or ADF personnel, police officer, public servant or charity worker.
Please forward your nomination to:
Post: Queensland Disaster Heroes
Department of the Premier and Cabinet
PO Box 15185
City East QLD 4002
Email: heroes@premiers.qld.gov.au Fax: 07 3224 4065
Entries close Friday 1 April 2011.
For more information visit www.queenslandweek.qld.gov.au
Thank you for your generous donations to the Premier’s Disaster
Relief Appeal. You can still make a difference by donating to the
Appeal at www.qld.gov.au/disasterappeal
Date

Conditions of nomination
1. Heroes are those people who have shown outstanding community initiative, bravery, courage, resilience and strength during the 2010–11
floods and/or Tropical Cyclone Yasi.
2. Nominations must be submitted by persons 18 years of age or over.
3. Nominations must be received on an official nomination form with all questions completed.
4. Nominations must be endorsed by a local councillor, state or federal MP, emergency services or ADF personnel, police officer, public
servant or charity worker.
5. Supporting documentation submitted with nominations will be retained by the State of Queensland through the Department of the Premier
and Cabinet (the department).
6. The department’s decision is final on all matters relating to the nomination process and the selection of recipients,
and no correspondence will be entered into.
7. The department reserves the right to disclose the identity of the nominator to the nominee.
8. The nominator’s and/or nominee’s name, image, statement or otherwise may be published and/or used in any form of media, in any
context pertaining to the program. Personal information about an individual will only be disclosed in this manner if the individual
consents to such disclosure. Nominators are requested to sign the nominator declaration on the nomination form including the privacy
consent. Individuals are free to give or withhold such consent at their discretion, however the department will be entitled not to accept a
nomination, or to withdraw a nominee from consideration for the program at any time prior to the public announcement of winners, if the
necessary consent is not provided.
9. Recipients will be honoured with a medal. A person cannot receive more than one medal.
10. Entries close 5pm Friday 1 April 2011.
11. The department may change these conditions of entry or cancel or vary the program process at any time, whether before, on or after the
closing date.
Privacy information
The Department of the Premier and Cabinet (the department) is collecting your personal information in accordance with the Information
Privacy Act 2009 (Qld), in order to coordinate/administer the Queensland Disaster Heroes program (the program) and any events in
connection with the program. The information will be stored securely and accessed only by the department’s authorised employees for the
purposes specified above, or for the purpose of contacting you regarding future Queensland Disaster Heroes, or other programs and events
administered by the department. Personal information may be disclosed to third parties as specified in the conditions of nomination for the
program. Your personal information will not be disclosed to any other third party without your consent, unless authorised or required by law.
If at any time you would like your personal information removed from our database, please send your request to
heroes@premiers.qld.gov.au or fax to 07 3224 4065.
DPC2449 Image by: Britt Carseldine