Builder Nomination Form

Part A:

PLEASE NOTE: Use of the nomination form is mandatory. Nominations received in a nonstandard format will be returned for re-submission. Nomination deadline is June 1st annually.

PARTICIPATION AS A BUILDER

NOMINATED FOR PARTICIPATION IN THE FOLLOWING SPORT(S):*

Name:*

Address:*

Street Address City Province Postal Code

Telephone(Work):*

Telephone(Home):

Fax:

E-mail:*

Date of Birth:*

Place of Birth:*

IF DECEASED PLEASE INDICATE YEAR OF DEATH:

NEXT OF KIN: (relationship)*

Address:*

Street Address City Province Postal Code

Telephone(Home):*

Telephone(Business):

NOMINATOR NAME:*

Address:*

Street Address City Province Postal Code

Telephone(Work):*

Telephone(Home):

Fax:

E-mail:*

Date of Nomination:*

Signature of Nominator:*

Part B:

PLEASE LIST DETAILS OF NOMINEE'S CAREER AS A BUILDER, INCLUDING NAMES OF ORGANIZATIONS, POSITIONS HELD, YEARS OF SERVICES AND CHAMPIONSHIP PARTICIPATION. IF MORE SPACE IS REQUIRED PLEASE ATTACH ADDITIONAL PAGES.*

Part C:

MERITORIOUS ACHIEVEMENTS: (Please list awards & honours bestowed upon the nominee during, or a result of, their building career). IF MORE SPACE IS REQUIRED PLEASE ATTACH ADDITIONAL PAGES.*

IF THE NOMINEE HAS CONTRIBUTED TO SPORT IN WAYS NOT COVERED BY SECTIONS B AND C, PLEASE PROVIDE DETAILS HERE. IF MORE SPACE IS REQUIRED, PLEASE ATTACH ADDITIONAL PAGES.*

Nominations shall reflect upon the character and conduct of the person or persons nominated. This information should be supported by letters of reference from exemplary individuals from the organization and/or community.

Submit to:

Induction Selection Committee
Regina Sports Hall of Fame and Museum
P.O. Box 3763
Regina, SK S4P 3N8

Or Email: reginasportshall@hotmail.com

Builder Nomination Form

Interested in helping support the Regina Sports Hall of Fame?

Interested in helping support the
Regina Sports Hall of Fame?