Wall of Fame Nomination Form

NOMINEE:

Nomination is for: select one *

Name of Nominee: *

Address

Phone Number *

Email Address

Complete the following for athlete and builder.

Date of Birth *

Place of Birth *

If Other, please specify:

Is the nominee retired from sport? *

If yes, year of retirement (leave blank if unknown)

Is the Nominee deceased? *

If yes, year Nominee passed away

How long has the nominee lived in the Battlefords? *

Is the Nominee aware of the nomination? *

SPORT ACHIEVEMENT:

Name of sport nomination is for:

Level of involement:

Please provide a complete narrative on a separate piece of paper describing the activities and achievements of the person or team being nominated. Include paper clippings, documentation, etc. as well as why you feel your nominee should be selected. Narratives should include how the person or team is connected to the Battleford Community. All necessary proof to substantiate your information should accompany this application. All nominations will be required to submit a photograph; physical photographs may not be returned. Please note: incomplete nomination forms will be returned for further information and may not be eligible for this year's consideration.

File Upload *

File upload is limited to 20 MB pdf, doc, docx, xls, xlsx, ppt, pptx, odt, ods, odp, txt, jpg, png.

File Upload

File upload is limited to 20 MB pdf, doc, docx, xls, xlsx, ppt, pptx, odt, ods, odp, txt, jpg, png.

NOMINATOR:

Nominator Name *

Nominator Address *

Phone Number *

Email Address

I certify that the information provided in this form is true and accurate to the best of my knowledge.

Signature *

Date *

* - denotes required field