GIPPSTAR Gippsland Champion Nomination Form 🏆✨
Please complete the form to nominate a person who commenced their sporting career with a Gippsland Club and/or Association in their sportthat they are seeking to be recognised as a “Gippsland Champion”. They must have a strong family association with Gippsland and been permanently residing outside of the Gippsland region at the time of their nomination to be eligible for this prestigious award in the current Gippstar year (July - June).
Nominator Details
Name
*
First Name
Last Name
Relationship to Nominee
*
(club member/supporter/volunteer etc)
Mobile Number
*
Please enter a valid phone number
Format: 0000 000 000.
Email Address
*
example@example.com
Nominee Information
Nominee Name
*
Age
*
Sport
*
The Nominee competes as an
*
Please Select
Individual
Member of a Team
The Nominee competes at the following level
*
Please Select
National
International
World
Olympics/Paralympics
Nominee Contact Email
*
example@example.com
Nominee Mobile Number
*
Please enter a valid phone number
Format: 0000 000 000.
Nominee Profile
Brief Overview
*
Please provide a brief overview of the nominee's role within their sport
The nominee has a strong family connection with Gippsland, starting his/er sporting career in Gippsland with the following Sporting Club/Association
*
The nominee has resided outside of the Gippsland Region for
*
years
The nominee currently lives in
*
town/country
Achievements
The major achievements he/she has attained in his/her sporting career during the current Gippstar year
*
Photos
Photo requirements
Nominee Photo 1
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Nominee Photo 2
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Permission and consent confirmation
*
I confirm that permission has been obtained from all individuals shown, or from their parent/guardian where applicable, for use in promotional, publication, social media, and awards materials.
Declaration
Declaration
*
I declare that the information provided is true and correct.
Nominator Name
*
First Name
Last Name
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit Nomination
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