Museum - 50 Voices for 50 Years Nomination Form

An everyday story today - becomes an important piece of our local history tomorrow.

Nominate a person you think we should interview.

Your Name*

Your contact phone number*

Your email address*

Nominee's name*

Nominee's contact phone number*

Nominee's email address*

Nominee's residential address*

Nominee's age*

How do you know this person?*

Why are you nominating this person?*

How long have they lived or worked in the Esperance region?*

Are they connected to any significant events, industry or community life?*

What topics should we talk about with this person?*

Have you asked this person if they would like to be interviewed?*

Yes we have discussed thisHave discussed it a bitHave not told them about it

Is this person willing to be interviewed?*

Yes, they are willingThey might be - I have not askedNot sure - have not asked

Is the Nominee available for an interview between 1 September 2026 and 30 October 2026?*

Yes they would be availableMight be - would have to check on datesNot sure - have not asked

Is there anything else we should know about this person?*

Collection Notice

By submitting this form, you acknowledge that the Shire of Esperance collects and uses personal information for the purpose of administering its services and functions such as maintaining accurate records, and meeting legal, reporting, and governance obligations. For more information about how we collect, use, and store personal information, please refer to our Privacy Policy.

Museum - 50 Voices for 50 Years Nomination Form

An everyday story today - becomes an important piece of our local history tomorrow.

Nominate a person you think we should interview.

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