Builder Nomination Form

NOMINATION DEADLINE: JANUARY 4, 2016


This form may be typewritten, printed neatly in pen, or submitted electronically. The requested information must be provided on the nomination form and your total submission must not exceed ten (10) pages, including supporting material. This nomination must have the consent of the nominee, or if deceased, by a family member.


PERSONAL INFORMATION OF NOMINEE

First Name:
Middle Name: 

Last Name:

Nickname(s):

Date of Birth:

Place of Birth:

Current Address:

City:                                           
    
Province:

Postal Code:

Email:

 
Home Phone:

Cell Phone:

Work Phone:

Nominee's Signature:


Date:

 


INFORMATION OF NOMINATOR(S)

(Must be a paid member of Wood Buffalo Sports Hall of Fame Society)


Nominator(s) Name:

Email:

Home Phone:

Work Phone:

If from sporting association related to nominee, name of group:





CAREER INFORMATION
Competitive Sports in which the Nominee has excelled:
Primary Sport:

Dates:
From:     To:
Secondary Sport(s):

Dates:
From:     To:

From:     To:

From:     To:
  
What functions(s) best identifies the nominee’s contribution to sport? Please specify: administrator, official, technician, coach, educator, organizer, sponsor, patron, or combination thereof?

Level of Significance of Contribution:
Specify the nominee’s contribution to the growth and development of sport in Wood Buffalo through his/her involvement at the local/community level; the provincial level and the national/international levels; and describe the impact the nominee has had on the sport.

Local/Community Level:


Provincial Level:


National/International Level:


Personal Awards/Recognition:
Please include dates and relevant information. Include medals, trophies (MVP, All-Star selections) not included above. Please include all records established by the nominee and recognition such as Athlete of the Year, admission to Halls of Fame, etc.


Striving for Success:
Please provide information to illustrate the dedication and perseverance of the nominee. Include information on training practices, unusual or unusual or difficult circumstances encountered, etc. Include information on the number and quality of other competitors involved at the time and the significance of the nominee’s achievements.


Contribution over time:
Please provide information to illustrate nominee's involvement with and dedication to sport over time.


Personal Qualities:
Please provide information on the nominee's leadership qualities, character, sportsmanship and contributions to sport and the community.




I hereby declare that to the best of my knowledge all of the above information is accurate and correct.

Name:

Date:


NOMINATION DEADLINE: JANUARY 4, 2016

Additional information that may be included with Nomination Form:

  • A 5 x 7 or 8 x 10 colour or black/white photograph
  • Letters of support
  • Newspaper articles/videos/photographs
  • Copies of awards, certificates, citations, etc.





Nomination forms may be delivered after obtaining five (5) signatures of Wood Buffalo Sports Hall of Fame Society Members to:
Wood Buffalo Sports Hall of Fame
Box 10, 8115 Franklin Avenue
Fort McMurray, AB T9H 2H7
Telephone: 780.381.1213


For more information contact:
admin@woodbuffalosports.com