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NOMINATION FORM:? (2 pages will download)

Nominee name:_____________________________________________________________

Address:___________________________________________________________________________________________

Phone:__________________????Cel:___________________???????E-mail:_________________________

Category: ? (______ Athlete) ????(______ Coach)?? ??(______ Builder)??? (______ Team)

Sport(s):________________________________________________________

List Accomplishments in this area in descending order: (Attach supporting documents)??

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?How did you hear about the Burnaby Sports Hall of Fame? ___________________________

Nominated by:____________________________________________________

Address:__________________________________________________________________

_________________________________________________________________________

Phone:_____________________________ ??Cell:_________________________????E-mail:____________________________

Signature:____________________________________???????Date:_________________________

Send Nomination Form to:
Nomination, Jill Porter
Burnaby Parks, Recreation and Cultural Services,
#101 - 4946 Canada Way,
Burnaby, B. C. V5G 4H7

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