Nomination Form

When making your nomination, please provide short statements describing how the nominee meets the award criteria. Where possible, provide examples to support the statements.
Nominee details
Name : 
Surname Name :
Nominee’s postal address: (If known)
Nominee’s phone number: (If known)
Nominee’s email address:  
Name of sporting organization the nominee provides volunteer services to:
Nominee’s length of volunteering service (i.e. number of years):
Why are you nominating him or her?

Nominated by

Name :  
Organization : 
Address : (include postcode)
Telephone :
Mobile :  
Relationship to nominee :


Name of referee 1 : Address: (include postcode)
Phone number : Email address :

Name of referee 2 :

Address : (include postcode)
Phone number : Email address :

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