Individual Nomination Form - Halton Hills Sports Hall of Fame

Nominee Personal Information

First

Last

Nominee Category

Sport

Street Address

City

Province

Postal Code

Confirm Email

Phone Number

Years living in Halton Hills

Birthdate

Birthplace

Local Schools Attended (if applicable)

Accomplishments

Please list the Year, league / level (National, Provincial, Local) and achievement (Awards, Records, Championships). Each accomplishment should go on a new line.

Other Information

Expand on the accomplishments listed above, significant/pivotal moments, game scores or details, context or significance of achievements. If this includes supporting documentation, including letters of reference, photographs, newspaper clippings, links to online stories or other supporting documents, they can be emailed to herb_garbutt@hhsm.ca.

(if Family Number

Is nominee deceased?

If nominee is deceased, please complete Family Contact Info section

Family Contact – Name

First

Last

Please fill out this section if the nominee is deceased

Family Contact – City

Family Contact – Province

Family Contact – Postal Code

Family Contact – Email

Confirm Email

Family Contact – Phone Number

Nominator Name

First

Last

Street Address

City

Province

Postal Code

Confirm Email

Phone Number

Reference Name

First

Last

Please provide at least one reference in order to assist the selection committee in compiling information and/or assessing the nominee.

Street Address

City

Province

Postal Code

Confirm Email

Phone Number

Agreement

I confirm this submission

In checking the box above, you agree and confirm that all information submitted above is accurate to the best of your knowledge.