Nomination Form

Please fill out this form in its entirety. It must be TYPEWRITTEN or CLEARLY PRINTED. Attach additional sheets if required. Please include any supporting documentation including photographs, articles or other information available.

Nominee Information
1.	Name (in full) of Nominee:
	Nickname (if any):
2.	Place of Birth:
	Date of Birth:
	If the Nominee was born outside of Canada, what year did he/she arrive and/or attain Canadian citizenship?
3.	Current address:
	Telephone:
4.	If deceased, date of passing:
	Where?
	Next of Kin (name and address)
	Telephone:
5.	Which category is the Nominee to be considered for nomination? Athlete Professional Builder
Career Information
6.	Please list below the Nominee's major achievements and contributions and include the dates when each occurred and level of competition.
7.	Please list Nominee's personal attributes with relation to skill, character, dedication and overall contribution.
8.	Please list any awards won (include dates and related information) or other forms of recognition earned by Nominee.
9.	Please provide any additional comments concerning the Nominee's contribution to the sport of figure skating in Canada or provide general information you feel warrants consideration by the Selection Committee.
It is IMPORTANT to include the following DOCUMENTATION: Photographs News clippings or magazine articles Letters of support Any other items deemed important to nomination
Nominator (person or group):
Address:
Telephone:
Date submitted:

For office use only:
Date Received:	Acknowledged by:	Photographs (#)
		Attachments (#)