Nomination Form – Builder Category – LUNENBURG COUNTY SPORT HERITAGE SOCIETY

BUILDER INFORMATION

In this section, you will enter information about the Builder you are nominating for enshrinement in the Lunenburg County Sport Heritage Society (LCSHS) Wall of Fame. Please click here for complete eligibility requirements.

Upon completing the entirety of this form, please click the “Submit” button at the very bottom of this page to forward your completed application to the LCSHS.

Your nomination package has been sent!

Your message has been sent. Thank you for taking the time to submit a nomination form. A representative from the LCSHS will be in contact with you. Please allow up to one week for a response.

Name of Nominee in the Builder Category

Date of Submission

Name of Team Contact

Address of Team Contact

Phone and/or e-mail contact of Team Contact

Date of Birth

Place of Birth

Years residing in Lunenburg County (e.g. 1985 to 1996)

Date of death of Nominee (if applicable)

Next of Kin (if applicable)

Contact information (phone number and e-mail address) for next of kin

NOMINATOR INFORMATION

By checking this box, as the Nominator, you verify that all information included in this application is accurate and timely to the best of your knowledge, and that all package requirements have been included. Checking the box also verifies that you understand that all supporting documents, including photos, become property of the Lunenburg County Sport Heritage Society and will not be returned.

By checking this box, I signify that I understand that as the Nominator I will be required to also provide two signed letters of support for the Nominee that will be provided either as attachments on this page or subsequently to the Chairperson for the LCSHS Board of Directors.

Name of Nominator

Relationship to Nominee

Mailing Address

Phone Number

E-mail Address

BUILDER’S PROFILE AND ACCOMPLISHMENTS

In this section, you will provide details about the Nominee Builder’s achievements and contributions. Please provide as much detailed information as possible in order to ensure the nomination is complete and competitive. A minimum of three major accomplishments should be included in any solid nomination package.

Sport(s) of prominence

Lunenburg County Roots/Connection

Championships

Contribution to Sport in Lunenburg County

Accomplishments 1 – Year or Year Range

Accomplishments 1 – Team/Organization and level of competition – local, provincial, national, international)

Accomplishments 1 – Achievement Details (Highlights, titles, medals, records)

Accomplishments 2 – Year or Year Range

Accomplishments 2 – Team/Organization and level of competition – local, provincial, national, international)

Accomplishments 2 – Achievement Details (Highlights, titles, medals, records)

Accomplishments 3 – Year or Year Range

Accomplishments 3 – Team/Organization and level of competition – local, provincial, national, international)

Accomplishments 3 – Achievement Details (Highlights, titles, medals, records)

Accomplishments 4 – Year or Year Range

Accomplishments 4 – Team/Organization and level of competition – local, provincial, national, international)

Accomplishments 4 – Achievement Details (Highlights, titles, medals, records)

Use this space to provide additional details on the Nominee Builder’s accomplishments and contributions to sport in Lunenburg County that the Selection Committee and Board of Directors should be made aware of:

Describe the Nominee’s leadership skills, character, sportsmanship, or other areas of community service, and the ability to work well with others.

Statement of Recommendation: Outline the nominee’s contribution to the growth and development of sport in Lunenburg County. Provide
information to illustrate the nominee’s personal commitment, their perseverance on behalf of the sport, and dedication to sport over time. If applicable, also outline their involvement at the regional, provincial and
national, and international levels.

Use this field to upload documents that support your nomination package, including photos and newspaper clippings.

Drag and drop or click to select a file.

Upload a file

Drag and drop or click to select a file.

Upload a file

Drag and drop or click to select a file.

IMPORTANT INFORMATION
Deadline for all submissions is April 15 annually. Induction typically takes place in early November, with candidates for induction in a given year generally confirmed by June.

For questions or concerns, please contact the co-chair of the Lunenburg County Sport Heritage Society, Mark Nelson, at 902-543-4085.

BUILDER INFORMATION

Your nomination package has been sent!

NOMINATOR INFORMATION

BUILDER’S PROFILE AND ACCOMPLISHMENTS

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