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SECTION A: Personal Information 1 SECTION A: Personal information 1. a) Nominees Name in full:__________________________________________________ Nickname if any:______________________________________________________ Current Address_______________________________________________________ ____________________________________________________________________ Telephone:____________________________ 1. b) Complete only if deceased: Date of Death: ________________________ Next of Kin: __________________________ Relationship:____________________ Address:_____________________________________Telephone:______________ 2. Place of Birth: __________________________Date of Birth:___________________ Country of Citizenship: _________________________________________________ 3. Educational Background: ________________________________________________ 4. Present or most recent Occupation :_______________________________________ 5. Golf Club Affiliations: Club Name Pro. Or Am. Years: From – To _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 6. Please check below the role in which the Nominee has been most outstanding. Amateur Golfer: Professional Golfer: Golf Administrator: Course Design/Management: Other; Please indicate:______________________________________ Definitions: Amateur or Professional Golfer: Shall be a person who has an outstanding record in competitive golf at the national and/or international level. Administrator: Shall be a person whose career has had a major impact on the growth and future direction of the sport of golf on the national and/or international level. Course Design/Management: Shall be a person who has had an illustrious career in golf course design, the management of golf facilities, or the maintenance of golf facilities in Canada. Other: Shall be a person who has made an exceptional contribution to promoting the sport of golf and may include jour- nalists, financiers, inventors, etc, on a national and/or international level. CANADIAN GOLF HALL OF FAME SECTION B: Major achievements in the sport of golf Please list the Nominee’s golf related achievements in chronological order. If more space is required, please attach an additional sheet. ACHIEVEMENT YEAR National:___________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ International:_______________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ CANADIAN GOLF HALL OF FAME 2 SECTION C: Listing of awards and recognitions Please list all golf related awards, including admission to Provincial Hall(s) of Fame. Prestigious awards unrelated to golf may also be included here. NATURE OF AWARD/RECOGNITION YEAR __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ SECTION D: Significant circumstances 1. Difficulty in achieving successes. If there is an uncommon commitment or perseverance required to overcome unusual or difficult circumstances, please describe this. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 2. Contribution over time. If the Nominee has made a significant commitment to the sport over a long period of time please illustrate this. List the number of years with positions held, etc. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 3. Other significant items. This is an optional space which may be used to provide other supporting information which lends further significance to the Nominee’s achievement. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ CANADIAN GOLF HALL OF FAME 3 SECTION E: The nominator 1. Name: Person/Association: _________________________________________________ If Association, give contact name:__________________________ Title:_____________ Telephone: ______________________ Email Address: __________________________ Address:________________________________________________________________ 2. Relationship to the Nominee:________________________________________________ Are/were you personally acquainted with the Nominee? Yes ____ No ____ 3. Declaration of Authenticity; I declare that to the best of my knowledge all of the information provided on this nomination form is accurate and correct. Nominator’s Signature:____________________________Date:____________________ 4. Seconding the Nomination. I, too, declare that to the best of my knowledge all of the information provided on this nomination form is accurate and correct. Signature:_________________________________Date:_________________________ Name (please print):______________________________________________________ Organization (if relevant):_____________________Title:_________________________ Phone Number(s):________________________________________________________ 5. Enclosures: Required: A nomination form completed in all respects. A black & white or colour photograph of the nominee. (5x7 or 8x10) Optional: Copies of letters; clippings; certificates or other material which will support the significance of the nominee’s
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