Premier’s Service Club Awards

Please provide FULL and ACCURATE Club Information

Name of Submitting Club:

ABN:

Postal Address:

Email:

President’s Name:

Name of Contact Person:

Contact Phone No:

Name of Bank Account:

BSB Number

Account Number

Number of Members in your Club at time of project:

Project Information

Project Name:

Project Category:

Project Summary (one paragraph brief description):

Please attach description of project (no more than 500 words) that outlines:

All nominations must be received no later than Close of Business on 31st August 2022

Completed nomination forms should be emailed to

or by post to SCASA Nomination C\- PO Box 123, Park Holme SA 5043