GIPPSTAR Special Achiever Nomination Form 🏆✨

GIPPSTAR Special Achiever Nomination Form 🏆✨

Please complete the form to nominate a person who has provided outstanding service to sport over a significant period of years for this prestigious award in the current Gippstar year (July - June).
Nominator Details
Name

First NameLast Name
Relationship to Nominee
(club member/supporter/volunteer etc)
Mobile Number
Please enter a valid phone numberFormat: 0000 000 000.
Email Address
example@example.com
Nominee Information
Nominee Name
Sport
The Nominee is an
The Nominee has held this position with their club/association for
Club/Association
Location

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Nominee Contact Email
example@example.com
Nominee Mobile Number
Please enter a valid phone numberFormat: 0000 000 000.
Nominee Profile
Brief Overview
Please provide a brief overview of the nominee's role within their sport
Achievements
Achievement Summary
Excellence and Impact
Why should this person be considered for the award?
Significant challenges overcome
Contribution to Gippsland sport
Photos
Photo requirements
Nominee Photo 1

Cancelof
Nominee Photo 2

Cancelof
Permission and consent confirmation
Declaration
Declaration
Nominator Name

First NameLast Name
Date

MonthDayYear
Date
Should be Empty: