COPY AND PASTE...
then follow the instructions to send your nomination(s) in
GEORGETOWN HOCKEY HERITAGE COUNCIL AWARD
NOMINATION FORM
The following information is requested so that the person, organization or team being nominated can be considered for the GHHC Award. (Please see “Georgetown Hockey Heritage Council Nomination Criteria” at “The GHHC.com”).
Please include photocopies of newspaper clippings or bios from relevant hockey governing bodies to validate your submission. The signature of the nominator is required (See Section “C”).
Self-nominations are not permitted.
A nominator will receive a letter or email from the GHHC Selection Committee Chair within 10 business days confirming receipt of the Nomination Form.
PLEASE RETURN THIS FORM FULLY COMPLETED no later than 5:00 p.m. on the last Friday of the month of October.
IMPORTANT – If the person, organization or team named in this form is nominated and subsequently selected for a GHHC Award, this information will be used to generate media coverage of this event, focusing on the career and contributions of the nominee. If not chosen during the submission year, this form and information will be maintained on file for consideration in future years. The Selection Committee Chair shall advise the nominator in writing of the status of the nomination following the formal meeting of the Selection Committee.
NOMINEE PERSONAL DATA:
Full Name: _____________________________________________________________________
(SURNAME) (GIVEN NAMES)
Nickname: ______________________________________________________________________
Address: ________________________________________________________________________
City / Postal Code: _____________________________________________________________________
Telephone: (H) ________________(B) ____________________(C)______________________
Email: _______________________________________________________________________
Birthdate: _______________________ Place of Birth: _________________________________
NOMINATION CATEGORY:
“Hockey Heritage Council Award” _______ “Citation Award”: _______
”Murray Ezeard Plaque”:________
SECTION B
I submit this nominee for consideration to the Georgetown Hockey Heritage Council based on contributions in the following areas: (please select all that apply)
Team / League Executive: _______________
Coach / Team Manager: _______________
Player: _______________
Official: _______________
Other: _______________
Involvement:
Team / League/ Association – Year(s), Competitive Level, Position:
Total Years Involved in Georgetown Hockey to date: _______________
Still Active: Yes_________ No _________
Major strengths: (i.e. fundraiser, team organization, leadership, educator, length and strength of support, innovative player, volunteer, etc.)
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
SECTION B (continued)
Special Awards or Recognitions – list award(s), team/league/association and year of the award:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Briefly state your reasons for nominating this person, organization or team for this Award:
________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Please list what you believe to be the 3 main accomplishments of this person, organization, or team.
- ______________________________________________________________________
______________________________________________________________________
- ______________________________________________________________________
______________________________________________________________________
- ______________________________________________________________________
______________________________________________________________________
SECTION C
NOMINATOR INFORMATION
So that you may be contacted for further information, if required, please list your contact information below:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
City/PostalCode:___________________________________________________________________
Telephone: (H)___________________(B)______________________(C)___________________
E-mail: _______________________________________________________________________
Signature: __________________________________Date Submitted: _____________________
(To the best of my ability, I declare all information submitted to be factual and accurate)
SOURCES:
For the purposes of compiling information on the Nominee to assist with the selection process,
the GHHC requests two (2) references:
1. Name: ______________________________Telephone #:_____________________________
Address: ______________________________________________________________________
Email: ________________________________________________________________________
2. Name: _____________________________Telephone #:______________________________
Address: _______________________________________________________________________
Email: _________________________________________________________________________
Signature of Selection Committee Member (Sponsor): _____________________________________
Please return the completed Nomination Form to GHHC Selection Committee
By Mail:
GHHC Selection Chair
Ron Lefebvre, 8 Meagan Dr Georgetown ON L7G 5G8
or
GHHC Chairman
Mike Daquano 59 Stockman Cres, Georgetown, ON L7G 1J5
By email:
Ron Lefebvre or Mike Daquano
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