Nomination Form - Outstanding Services

I understand the shortlist panel can only take into consideration and therefore make their decision based on the information provided on this application only.

Question Title

* 1. Award Category:-

Outstanding Services to Sport

Question Title

* 2. Nominee Details

Name of Nominee

Club

Sport

Address

Postcode

Email

Phone Number

Age

Question Title

* 3. Nominator Details

Name

Address

Postcode

Phone Number

Email

Capacity in which nominee is known to you

Question Title

* 4. How many years has the nominee been volunteering?

Question Title

* 5. Briefly describe the voluntary/coaching activity carried out by the nominee (please include what specific roles the individual holds within the club)

Question Title

* 6. Please describe the impact that the nominee has made to an individual, team or club.

Question Title

* 7. Please use this section to provide further details on why you think your nomination is worthy of winning the award.

Question Title

* 8. I confirm that the information given is correct, to the best of my knowledge

I confirm

Question Title

* 9. I am happy for the information on this nomination form to be used in any publicity for the award, eg, press notices, social media, websites

Yes

No