GOLD COAST SPORTS Stars OF THE YEAR

NOMINATION FORM

Are you nominating yourself or someone else? *MyselfSomeone Else

Relationship to Nominee *

Your Name *

Your Email Address *

Your Phone Number *

First Name *

Last Name *

Email Address *

Mobile Phone No. *

Date of birth *

Your suburb of residence *

Place of Birth *

Which category are you applying for? *

Current Sport *

Have you competed in the last 12 months in any other sports?YesNo

List any other sports *

Achievements and Records *List any notable achievements, records or milestones

Description of your sporting journey *Briefly describe your sports career.

Reason for nomination? *

Upload your photograph (JPG Format no more than 10MB) *

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Letters of Endorsement/ Support

Drag and Drop (or) Choose Files

Please include any letters of endorsement from Sporting Bodies and Associations.

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Gold Coast, Australia