Georgetown Hockey Heritage Council

Recognizing Outstanding Contrbution to Georgetown's Hockey Heritage Since 1978

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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.
  1. ______________________________________________________________________
          ______________________________________________________________________
  1. ______________________________________________________________________
          ______________________________________________________________________
  1. ______________________________________________________________________
           ______________________________________________________________________
 
 
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
Chair, Paul Yates 16 - 59 Maple Avenue, Georgetown ON L7G 1X8 or Ray Inglis 7 Ostrander Blvd Georgetown, ON L7G 1Z2 before 5:00 p.m. on the last Friday of the month of October
. OR email it to either
PAUL YATES or RAY INGLIS

 


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