Honouree Individual Nominations

Honouree Information

Nomination Categories (required):
Individual

Participating Sport(s):

Format: Soccer, Hockey, Football

Full Name

First Name (required):

Format: Joe

Last Name (required):

Format: Smith

Initial:

Nickname:

Contact Information

Address:

Format: 100 Main Street, Brantford ON N3T 5R7

Email:

Format: joe.smith@domain.com

Home Phone:

Format: 519-123-4567

Work Phone:

Format: 519-123-4567

Demographics

Date of Birth:

Format: mm/dd/yyyy

Place of Birth:

Format: Brantford, ON

Deceased (Yes or No)?:
YesNo

Next of Kin

Next of Kin Name:

Format: John Doe

Address:

Format: 100 Main Street, Brantford ON N3T 5R7

Emaill:

Format: john.doe@domain.com

Home Phone:

Format: 519-123-4567

Work Phone:

Format: 519-123-4567

Career Information

Sports in which Nominee was Involved:

Format: Foorball, Baseball, Soccer

Primary Sport:

Format: Football

Secondary Sport:

Period Involved: From Date:

Format: mm/dd/yyyy &

Period Involved: To Date:

Format: mm/dd/yyyy &

Identify the Nominee's Contribution as a Builder:
AdministratorOfficial
TechnicianCoach
EducatorOrganizer
SponsorPatron

Information About Nominating Person or Group

Name of Person or Group:

Format: Wanda James or ABC Corporation

Address:

Format: 100 Main Street, Brantford ON N3T 5R7

Email:

Format: abc.corp@domain.com

Home Phone:

Format: 519-123-4567

Work Phone:

Format: 519-123-4567

Authentication

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

Signature:

Check the Box to Agree

Honouree Individual Nomination Form

Brantford and Area Sports Hall of Recognition

Honouree Individual Nomination Form

Features:

Brantford and Area Sports Hall of Recognition