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Commemorative Recognition Request Form

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This form is used to request commemorative recognition under the City of Kalamunda’s Commemorative Recognition Policy.

Please complete all sections and submit the form along with any required supporting documentation. 

Applicant Information:

Individual to be Recognised:

Type of Commemorative Recognition:

Select the type of commemorative recognition being requested:

Supporting Documentation:

The following documents must be attached to your application:
Attached a written biography or summary of the individual’s contributions
Attached any supporting materials (e.g., letters of support, historical records, or photographs)
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Applicant Declaration:

I, the undersigned, acknowledge that:


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