PLEASE NOTE: Use of the nomination from is mandatory.
Nominations received in a nonstandard format will be returned for re-submission.
Nomination deadline is June 1st annually.
NOMINATED FOR PARTICIPATION IN THE FOLLOWING SPORT(S):
___________________________________________ ___________________________________________
NAME:___________________________________________
ADDRESS: (please include postal code)
___________________________________________ ___________________________________________
___________________________________________
DATE OF BIRTH: __________________________________________
PLACE OF BIRTH: __________________________________________
IF DECEASED PLEASE INDICATE YEAR OF DEATH: _____________________
NEXT OF KIN: (relationship) __________________________________________
ADDRESS: (please include postal code) __________________________________________
__________________________________________ __________________________________________
ADDRESS: (please include postal code) __________________________________________
__________________________________________ __________________________________________
PLEASE LIST DETAILS OF NOMINEE'S COMPETITIVE CAREER AS AN ATHELETE INCLUDING NAMES OF TEAMS
(if applicable), YEARS OF INVOLVEMENT, CHAMPIONSHIPS ATTAINED, MEDALS WON, RECORDS AND AWARDS ACHIEVED
(e.g. most valuable player; all star selection). 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