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: ______________________________________________________________________ Age Restriction: Individuals must be at least forty (40) years of age to be nominated or elected; provided however, that the age requirement can be waived by Committee if an individual is deceased or if as a result of a career-ending injury, the individual has been retired for at least five (5) years. 3. Educational Background: ____________________________________________________________________ 4. Present or most recent Occupation: ___________________________________________________________ 5. Golf Club Affiliations: Club Name Professional or Amateur 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 journalists, financiers, inventors, etc, on a national and/or international level. Section B: Major Achievements in the Sport of Golf Please list the Nominee’s golf related achievments in chronological order. If more space is required, please attach an additional sheet. ACHIEVEMENT YEAR NATIONAL: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ INTERNATIONAL: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 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 REWARD 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. _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ 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