NOMINATION FORM
Sport Whanganui invite nominations for the Ray White 2016 Whanganui Sports Awards. Nominations close 5pm, Friday 7th October 2016
Section 1: About the Nominee Name of person/team you wish to nominate: Sport:
D.O.B:
Category: Contact Phone:
Contact Cell:
Email: Postal Address: Please select one category only. A separate form will need to be completed for each additional nomination, and please ensure you tailor your entry according to the category. The qualifying period for the 2016 Awards is 1 October 2015 – 30 September 2016.
Stirling Sports National Junior Sportsperson of the Year
Please note: If you have represented at International level, you cannot be nominated in this category. Open to any person who has excelled on a National level as an individual or in a team in one or more sports within the qualifying period. Nominees must be under the age of 21 years at time of achievement.
Velo Ronny’s Bicycle Store Sportsperson of the Year
International
Junior
Open to any person who has represented New Zealand as an individual or in a team in one or more sports within the qualifying period. Nominees must be under the age of 21 years at time of achievement.
NZCT National Senior Sportsperson of the Year
Please note: If you have represented at International level, you cannot be nominated in this category. Open to any person who has excelled at a National level as an individual or in a team in one or more sports within the qualifying period. Nominees must be over 21 years at time of achievement.
Mitre 10 MEGA International Senior Sportsperson of the Year Open to any person who has represented New Zealand as an individual or in a team in one or more sports within the qualifying period. Nominees must be over 21 years at time of achievement.
Stihl Shop Wanganui Club of the Year
Outstanding performance by a Club during the qualifying period.
(Complete information required in section 4).
Mars Petcare Coach of the Year
Outstanding performance by a coach within the qualifying period.
Treadwell Gordon Junior Team of the Year
Outstanding performance by a team of two or more persons within the qualifying period. Nominees must be under the age of 21 years at time of achievement.
Ali Arc Senior Team of the Year
Outstanding performance by a team of two or more persons within the qualifying period. Nominees must be over the age of 21 at time of achievement.
David Jones Motors Masters Award
Open to any person who has excelled as an individual or in a team in one or more Masters level sports within the qualifying period.
Rivercity Gas Disabled Sportsperson Recognition
Open to any person who has excelled as an individual or in a team in one or more sports as a disabled athlete within the qualifying period.
(Complete section 3).
Sport Whanganui Services to Sport Recognition
Open to any person who has contributed to sport as a volunteer within the qualifying period. Can include , but not limited to, committee member, administrator, umpire, coach, manager. Nominees will display the following qualities: positivity, inclusiveness, encouragement, vision, empathy, passion.
(Complete information required in section 5).
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Section 2: About the Nominator Name of Nominator: Contact Phone:
Contact Cell:
Email:
For Services to Sport Recognition nominations please turn to page 3.
Section 3: Nominee Credentials
1) Provide a descriptive summary of no more than 100 words on why this nominee should be considered for this category: (NOTE: Please ensure that the information relates to the category of nomination. This information may be used in the awards programme)
2) Please list the nominee’s TOP 3 achievements from 1st October 2015 until 30th September 2016. If you are nominating in Disabled Sportsperson or Services to Sport categories you may wish to skip this section.
DATE OF ACHIEVEMENT:
ACHIEVEMENT:
DATE OF ACHIEVEMENT:
ACHIEVEMENT:
DATE OF ACHIEVEMENT:
ACHIEVEMENT:
3) Please attach any additional information that would be helpful for the judges’ consideration of this nomination.
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Section 4: Additional Information Required for Club of the Year Nominations Please include here any additional information in support of your Club of the Year nomination. This will aid the judges in considering your nomination:
(Effectiveness of the Club – consider structure, planning,
volunteers, facilities, training and members; Competitions – consider successes of the club from juniors to seniors and pathways for juniors & elite; Contribution to the Community – consider opportunities for participation at all ages and levels, and the impact the club has on the community; Developments – consider all areas of development over the last year including membership growth, facilities, competition expansion etc. Continue on a separate page if necessary):
Section 5: Services to Sport Recognition Nominations
Provide a summary of no more than 200 words on why this nominee should be considered for this category: (NOTE: Please ensure that the information relates to the category of nomination. This information may be used in the awards programme)
Section 6: Notes on Nomination
Performance by nominees will only be considered when they have occurred during the qualifying period (1st October 2015 to 30th September 2016). Nominees under consideration for the awards must meet the criteria under (a), (b), or (c) below. a) Through residency in the Whanganui, Rangitikei or Ruapehu regions during the qualifying period. b) Through representing the Whanganui, Rangitikei or Ruapehu regions in their chosen discipline during the qualifying period. c) Through being commonly acknowledged as representing the Whanganui, Rangitikei or Ruapehu regions although not necessarily living in the region due to the demands of their international career.
All nominees must sign the following page to indicate acceptance of nomination.
TICKETS Tickets will be available from Sport Whanganui from Monday 10th October at a price of $60 each, or $30 for nominees. Full tables of 10 will be available for purchase at $550. Tickets are limited so please ensure you purchase well before the closing date of Friday 11th November.
Please note: If you are nominated in a team or club your team/club is entitled to up to 3 tickets at $30, any extra tickets will be $60. SEATS / TABLES CANNOT BE RESERVED. TICKETS WILL NEED TO BE PURCHASED IN ORDER FOR SEATS TO BE CONFIRMED.
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Section 7: Completing your Nomination Form I,
_________________________________________________have read the nomination notes over page and accept this nomination to enter the Ray White 2016 Whanganui Sports Awards, and understand that in accordance with the Privacy Act the information provided is for the sole purpose of activities and procedures related to the Ray White 2016 Whanganui Sports Awards. Further, I understand that in being nominated I agree to attend (or nominate a representative to attend on my behalf) the Ray White 2016 Whanganui Sports Awards to be held in Whanganui on Friday 18th November 2016. Nominee to Sign Here: _________________________________ Date: ___________________________
Please return your completed nomination form to: Sport Whanganui PO Box 516 40 Maria Place Extn, Whanganui Email: [email protected] If you have a photo of the nominee in action please attach a copy to this nomination form or send us an email.
For more information go to www.sportwhanganui.co.nz or contact Rachel on 06 349 2318 or email [email protected]
A big thanks to our PARTNERS Naming PARTNER
MEDIA PARTNERS EVENT PARTNERS
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