Celebrate our Centenarians Form

The City of Busselton proudly recognises residents who are turning 100 years or older. If you know someone in our community reaching this incredible milestone, we invite you to complete the form below. Upon notification, eligible centenarians will receive a personal letter of congratulations from the Mayor, celebrating their remarkable life and contribution to our region.

Let’s honour the lives and legacies of our oldest residents—because every century lived is a story worth celebrating.

Please submit your Celebrate our Centenarians Form at least one month prior to the recipient's birthday.

The City of Busselton collects personal information to process this form and provide the requested services. Information may be used for related City business purposes or disclosed where authorised by law. To learn how your personal information is handled, access the City’s Privacy Statement or contact the Privacy Officer at privacy@busselton.wa.gov.au.

Applicant Details

First name

Last name

Contact number

Email address*

Recipient Details

First name*

Last name*

Date of Birth*

Additional Information

Address where the Achievement Congratulatory Letter is to be sent*

Suburb*

Postcode*

State or Territory*

Please detail the recipient’s achievements, memorable moments, or anything else that you believe would make the recognition special

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