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Survey
EKSA Sports Awards Nomination Form 2016
Nominee Details
*
Indicates required field
Award Details / Category
*
Junior Sports Star of the Year
Senior Sports Star of the Year
Volunteer of the Year
Service to Sport
Official of the Year
Club of the Year
Please select one of the following categories for this nomination
Nominee Details; Name
*
First
Last
Date of Birth (only for Junior Sports Star)
*
Male/Female
*
Male
Female
Sport/s and Club/s
*
Please list the sporting group/club and type of sport you are nominating this person for
Nominee Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone Number
*
Nominator Details
Name of Club/School/Organisation
*
Please tell us which organisation, group or club you are submitting this nomination on behalf of, if you are nominating someone personally, please list self
Email
*
Name of Nominator
*
First
Last
Phone Number (Nominator)
*
Name of Seconder (if applicable)
*
First
Last
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Phone Number (Seconder)
*
Achievements
Please list the Nominee's achievements below
Local (East Kimberley) Achievements
*
List other Achievements
*
Please consider any Regional, State or National achievements of the Nominee
Any other details relevant to the Nominee's Best Performance
*
Please list contributions the Nominee has made to their Club
*
Grant/Funding Achievements
*
Other Hobbies and Interests
*
Please list any other information, such as volunteering, sporting or other achievements here
Why does the Nominee deserve the recognition
*
Please tell us why you're nominating this person
TERMS and CONDITIONS of ENTRY
The following terms and conditions apply for the 2016 East Kimberley Sports Awards. By submitting an official entry form into this competition, Nominators warrant that they have read, understood and agreed to be bound by them.
2016 nominations must be completed on the official 2016 Kimberley Sports Award Nomination Form (online or paper)
The judging panel will make the final decisions and no other correspondence will be entered into
Applications will be accepted on the following residential criteria:
The nominee will participate predominantly in sporting activities conducted within the East Kimberley unless the sport does not allow the opportunity to compete within the region;
The nominee is a member of an incorporated club or association based in the East Kimberley unless the sport does not allow the opportunity to compete as part of a club or association;
All nominations must be endorsed by an incorporated club or association unless the sport does not allow the opportunity to compete within the region.
The nominees shall be selected on their achievements, from 1 September 2015 till 26th August 2016.
Nominations will be accepted from Monday 18th July to 4pm Friday 26th August.
I (the Nominator - please enter your name in the box provided) have read and understood the eligibility criteria and the
terms and conditions
of entry and that acceptance or rejection my application will be determined by East Kimberley Sports Association Inc.
Name
*
First
Last
Submit