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Nomination Form

Name of Nominee:

Today's Date:

LivingDeceasedNominee number of years as resident in the Lakeshore Communities:

Nominee Contact Info:

(if Nominee is Deceased, please enter next of kin)

Address:

City:

Province:

Postal code:

Country:

Nominee Phone:

Nominee Email:

Nomination Category:

(choose one option)

Athlete (Modern)Athlete (Legend)BuilderOpen

Sport:

Team/Organization:

Dates Participated:

Involvement:

Summary of major achievements (MVP, All-Star, Championships, etc.)Highest level achieved:NationalInternationalProfessionalOtherIf Other please elaborate:

Recognition by other Sport governing body or Hall of Fame (if applicable):

Nominator Information:

Nominator name:

Address:

City:

Province:

Postal code:

Country:

Email:Phone Number:

I hereby certify that, to the best of my knowledge, the above facts are true and I endorse this application for induction into the Lakeshore Sports Excellence Hall of Fame.

*** Please accept electronic submission as signedElectronic Signature:

Thank you! Your submission has been received!

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Nominations received after the deadline must be resubmitted for consideration the following year.

The committee chair shall inform the nominator if their candidate has not been accepted for the current year and may encourage the candidate to reapply for the following year.

Our Mailing Address

Lakeshore Sports Excellence Hall of Fame,
PO Box 1180,
Belle River, ON
N0R 1A0