Canterbury-Bankstown Sporting Hall of Fame Nomination Form

The following information is required for an individual to be considered for inclusion in the Bankstown Sporting Hall of Fame.Additional information may be submitted as an attachment to this nomination form.

Nominator Details

Nominator first name

Nominator last name

Sporting body/Association

Position in sporting body/Association (if applicable)

Address

Street address

City

State

Postcode

Phone number

Email

Nomination Details

First name

Last name

Date of Birth

Place of Birth

Approximate timeframe and suburb of Bankstown that the nominee resided in

Type of Membership

Associate membership (coach/support)Full membership (Athlete)

Sport

Approximate time the nominee represented (e.g. 1975-1978)

Achievement or highest level of achievement i.e. finalist, medal winner, record holder (150 word limit)

Please provide any relevant additional information (100 word limit)

Upload a photo to be used in the Hall of Fame

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Privacy

In submitting this form, you consent to Council:

1. collecting your personal information as contained in the form; and

2. using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process your application/request.

You may access any of your personal information that Council holds upon request.

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Signature of Nominator *

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For additional information or assistance please contact City of Canterbury Bankstown on 9707 9000.