Required fields are marked with asterisks (*)

Scugog Sports Hall of Fame Nomination Form: Individual Athlete or Builder

Before completing the following form, please review the criteria for nominations.

Personal Information of Nominee

Category

Builder

Athlete

Nominee's Name (in full)

Nickname (if any)

Place of Birth

Current Address

Postal Code

Telephone

Date(s) of residency in Scugog or the Mississaugas of Scugog Island First Nation

Where educated [specify the Public School, High School, and University/College (where applicable)]

If the nominee is deceased, please list their next of kin, as well as their relationship to the nominee, address, postal code and telephone.

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