Team Nomination Form


PART A:

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.



TEAM NAME: __________________________________________

SPORT: __________________________________________

YEAR OF TEAM TO BE HONOURED: __________________________________________

CHAMPIONSHIP(S) WON: __________________________________________

LEVEL OF COMPETITION (PLEASE CHECK)

JUVENILE JUNIOR
MIDGET SENIOR
OTHER



STATUS (PLEASE CHECK):

AMATUER CLUB/CITY
PROFESSIONAL PROVINCIAL
HIGH SCHOOL NATIONAL
UNIVERSITY OTHER


PLEASE COMPLETE THE FOLLOWING:

NUMBER OF TEAM MEMBERS: __________________________________________

NUMBER OF TEAM MEMBERS THAT RESIDE IN REGINA DURING THE PLAYING YEARS __________________________________________

CONTACT PERSON FOR THE TEAM (FOR HALL OF FAME PURPOSES):

NAME: __________________________________________

ADDRESS: __________________________________________

TOWN/CITY:__________________________________________

POSTAL CODE: __________________________________________

EMAIL ADDRESS: _______________________________

TELEPHONE (Home)_____________________ (Business)_____________________



NOMINATOR: __________________________________________

ADDRESS: __________________________________________

TOWN/CITY:__________________________________________

POSTAL CODE:__________________________________________

EMAIL ADDRESS: _______________________________

TELEPHONE (Home)_____________________ (Business)_____________________

_______________________________________                 _______________________________________
(Date of Nomination)
(Signature of Nominator)

PART B:

TEAM ACCOMPLISHMENTS


PLEASE LIST DETAILS OF THE TEAM'S ACCOMPLISHMENTS, INCLUDING ANY MEDALS, TROPHIES OR TITLES WON BY THE TEAM. 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