Nomination Form

Please ensure that all details are provided in the spaces below.

I would like to nominate:

For the following category:
(please specify category/categories)

SPORTSMAN OF THE YEAR
Open to any sportsman who has excelled as an individual or in a team in one or more sports.
SPORTSWOMAN OF THE YEAR
Open to any sportswoman who has excelled as an individual or in a team in one or more sports.
REFEREE / UMPIRE / OFFICIAL OF THE YEAR
Outstanding performance by a referee / umpire / official.
COACH OF THE YEAR
Outstanding performance by a coach. As a result of the coaching this nominee’s athlete or team have achieved extraordinary success.
ADMINISTRATOR OF THE YEAR
Significant contribution by a sports administrator to improve their club / association / event.
TOP TEAM OF THE YEAR
Outstanding performance by a team.
JUNIOR SPORTSMAN OF THE YEAR
Open to any male individual under the age of 19 as at 30th September 2011.
JUNIOR SPORTSWOMAN OF THE YEAR
Open to any female individual under the age of 19 as at 30th September 2011.
JUNIOR TEAM OF THE YEAR
Open to any junior team with team members under the age of 19 as at 30th September 2011.
SERVICE TO SPORT(S)
Awarded to individuals honouring 15 years + of service to a club / association in any aspect of sport.
MASTERS AWARD
Outstanding performance by an individual in a masters’ grade category, as defined by the sports code.
CLUB AWARD
Awarded to a club which shows a commitment to development, innovation and implementation of a long term plan.

NOMINEE DETAILS

If nominating yourself, please complete the Nominator Details below also.

Postal Address *

Phone (9am - 5pm) *

Mobile

Date of Birth (Juniors/Masters only)

/ / (dd/mm/yyyy)

Email

Club/Organisation *

NOMINATOR DETAILS (Your Details)

Contact Name *

Club/Organisation*

Postal Address *

Phone (9am - 5pm)*

Mobile

Email *

SUMMARY OF ACHIEVEMENTS

Please complete with placings/results from 1 October 2010 to 30 September 2011. Finalists & category winners are determined primarily from the information provided by nominators, however information gathered by cmsport over the course of the nomination period may also be taken into consideration by the judges. Please do not use acronyms or sport specific terminology unknown to the layperson. Please be aware that judges may not have first hand knowledge of your sport.

International Achievements
(e.g. representing New Zealand in a sport)

National Achievements
(e.g. representing your club/organisation within New Zealand)

Regional Achievements
(e.g. representing your club/organisation within Counties Manukau)

Other Achievements

Details of Achievements
(This is your chance to expand on your nominees Summary of Achievements)

Verification Code *

In order for us to verify that you are a real person, please re-type these numbers and letters.

All information collected for the purpose of the Counties Manukau Sport 2011 Sporting Excellence Awards will be destroyed immediately after the event

Nominations close 20 October 2011. * Required fields