Newmarket Sports Hall of Fame Inductee Nomination Form

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Contact Information: Please provide the following information to allow the committee to contact you for further information, as required: Date Submitted: _________________________________________________________ Name: _________________________________________________________________ Address: _______________________________________________________________ City/Prov./Postal Code: ___________________________________________________ Telephone: (Home) _______________________ Business: _____________________ E-mail: ________________________________________________________________ Signature: _______________________________________________________________________ References: For the purposes of compiling information on the Nominee to assist the Selection Committee in judging, we requests three (3) references (at least one being from a non family member). Name: _______________________________ Telephone: _______________________ Address: _______________________________________________________________ Name: _______________________________ Telephone: _______________________ Address: _______________________________________________________________ Name: _______________________________ Telephone: _______________________ Address: _______________________________________________________________ Note: Please feel free to attach additional paper if required.
INDUCTEE CONSENT TO: THE NEWMARKET SPORTS HALL OF FAME RE: CONFIDENTIAL INFORMATION RE: INDUCTEE _________________________________________ (print Inductee’s full name) I, ____________________________________________, representing myself as the Inductee, (print Inductee’s full name) hereby consent and agree that the Newmarket Hall of Fame may collect and disseminate personal information regarding myself, the Inductee as set out above, for all promotional displays, media coverage in any format, including print or electronic media, certificates, exhibits, biographies, etc. DATED AT Newmarket this _____________________ day of __________________, 20____. _____________________________ ______________________________ Witness Inductee (Sign on line and print name below signature) (Sign on line and print name below signature) CONSENT OF PERSONAL REPRESENTATIVE
Page 1 and 2: Newmarket Sports Hall of Fame Induc
Page 3: Please state what you believe to be
Page 7 and 8: The Newmarket Sports Hall of Fame T
Page 9 and 10: or nation as being from Newmarket,

Newmarket Sports Hall of Fame Inductee Nomination Form

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