Nomination Form - Individual Player/Athlete and Builder

Category nominated:

Player/Athlete

Builder

PERSONAL INFORMATION

Nominee's name in full:

Nickname (if any)

Place of birth

Date of birth

Complete mailing address

Address

City/Town

Postal Code

Telephone

Dates of residency in Greater Moncton

Education

Public school

High school

University/Other

Spouse's name

Children's name(s) (ages bracketed)

Present or most recent occupation

If deceased, place & date

Next of kin

Relationship

Complete mailing address

Address

City/Town

Postal Code

Telephone

CAREER INFORMATION

Competitive sports in which the nominee was involved as a player or builder

Primary sport (list from - to dates):

Secondary sport(s) (list from - to dates)

PLAYER/ATHLETE NOMINEES ONLY

If retired from competition, what was the last year in which the nominee competed?

BUILDER NOMINEES ONLY

What function best identifies the nominee's contribution to sport?

Administrator

Official

Technician

Coach

Educator

Organizer

Patron

PLAYER/ATHLETE AND BUILDER INFORMATION

Outline the nominee's contribution to the growth and development of sport in Greater Moncton. If applicable also outline their involvement at the provincial, regional and national levels.

Personal awards/recognition (include dates and relevant information) e.g. Individual achievement awards, citations, certificates, conferred by community, provincial, national or international organizations, including admissions to Halls of Fame, etc.

Difficulty in achieving success. Provide information to illustrate the nominee's personal commitment, and his/her perseverance on behalf of the sport. Include any unusual or difficult circumstances which have made the contributions noteworthy.

Contribution over time. Provide information to illustrate the nominee's involvement with, and dedication to, sport over time. E.g. number of years service at each level, various positions held, etc.

Personal qualities. Provide information on the nominee's leadership skills, character, sportsmanship, other areas of community service, and the ability to work well with others.

Name of person/group submitting the nomination

Complete mailing address

Address

City/Town

Postal Code

Telephone

Date

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

NOMINATION DEADLINE

Nominations are accepted year round, however, those submitted prior to June 15 will be considered in that given year. All other submissions will be considered the following year.

Relevant photos and materials are to be delivered, or mailed to:

City of Moncton
Att: Recreation Department
655 Main Street
Moncton, NB
E1C 1E8

506-853-3333
info@moncton.ca

Nomination Form – Individual Player/Athlete and Builder

PERSONAL INFORMATION

Education

CAREER INFORMATION

PLAYER/ATHLETE NOMINEES ONLY

BUILDER NOMINEES ONLY

PLAYER/ATHLETE AND BUILDER INFORMATION

NOMINATION DEADLINE