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.
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 SUPPORT PROVIEDED TO SPORT IN REGINA BY THE INDIVIDUAL,
BUSINESS OR ORGANIZATION. 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