Nomination Form

#Pass On Your Passion 24th -30th July 2017

Women play a big role in influencing those around them whether that be at home, work or within their social lives, yet within the Sport and Physical Activity sector they are still largely underrepresented.

On 8th June 2017, Active Cheshire launched a brand new and exciting campaign to find Cheshire and Warrington’s unsung heroines who inspire, enthuse and support others to get active. Active Cheshire are launching #Pass On Your Passion in National Volunteer week and want to find females who enhance the lives of other people using physical activity by formally recognising their hard work, commitment and dedication.

Nominations are now open and will close on the 30th June

The campaign week will take place week commencing the 24th July 2017 and there will be a celebration event taking place on Thursday 27th July 2017.

Question Title

* About you (the person nominating)

Name *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address *

Phone Number *

Question Title

* How do you know the person you are nominating?

Work colleague

Friend

Family Member

Coach, Leader or activator of a session I or someone else attends

Health Professional (physiotherapist, midwife etc)

Teacher

Personal trainer

I volunteer alongside them

Other (please specify)

Question Title

* About the person you want to nominate

Name *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address *

Phone Number *

Question Title

* Is the person you are nominating part of an organised group, club or organisation?

Yes

If yes, please give the name

Question Title

* Is the person aware you have nominated them?

Yes

Unsure

Question Title

* Tell us why you are nominating this person? We ask you give us as much detail as you can, think about the following:

Has this person made a significant difference to you or someone you know?

How has the individual made an impact on you or someone you know?

How does this individual influence you or others?

Why do you they deserve recognition?

How has this person helped you or someone you know change their life?

How do they support and motivate others?

Question Title

* Please use this space to include a personal message of thanks to the person you are nominating. Think about how they make you feel, the difference they make and why you want to say thank you!

100% of survey complete.