Form

Required fields are marked with asterisks (*)

Wall of Fame Application Form

Please complete the following information to nominate to the Sport's Wall of Fame. April 30th cut off date.

Category (please check one). Please reference the Criteria for Nominations, to determine if your nomination is for a builder, athlete or team.

Team

Builder

Athlete

Nominee

Nominee:

Email address:

Mailing Address:

Postal Code

Phone No.

Birthdate

Nominator

Nominator:

Email address:

Mailing Address:

Postal Code

Phone No.

Attach Photograph of Nominee Please either attach a high resolution, high quality photo or provide a hard copy 8x10 photo of the team, athlete or builder to the Recreation Department to be used if the application is approved.

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Supporting information. Please complete this section with as much detail as possible including dates, location, accomplishments and spots/description. This is the write up that will be used for the plaque if the nomination is successful.

Minimum characters: 250

Support information. Please provide any additional support information that you think will be helpful when reviewing the application.

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Signature (use your mouse or touchpad to sign in the box below)

Clear

Date

Personal information is collected under the authority of the Municipal Act, 2001, S.O. 2001 for the purpose of creating a record to be used for considering "Sports Wall of Fame" applications. Questions about this collection should be directed to the Clerk of the Municipality of Kincardine at 1475 Concession 5, RR #5, Kincardine ON N2Z 2X6 or by phone at (519) 396-3468

Contact(s)