Bolsover District Council

Bolsover District Annual Sports Awards Nomination

Award Nominated For *

Details of Nominee

Name *

Date of Birth *

Address *

Contact phone number

Email address

Sport *

Name and Address of Club and School (where applicable)

Details of Person Nominating

Name *

Address *

Contact Phone Number *

Relationship to Nominee *

Achievements

For performance categories marked as * on the criteria form please list the top 5 achievements and dates in order of importance for the period September 2010 – August 2011.

Achievement One

Individual Performance Achievment and Team Achievements only

Date

Level

Achievement Two

Individual Performance Achievement and Team Achievments only

Date

Level

Achievement Three

Individual Performance Achievement and Team Achievments only

Date

Level

Achievement Four

Individual Performance Achievement and Team Achievments only

Date

Level

Achievement Five

Individual Performance Achievement and Team Achievments only

Date

Level

Reasons for Nomination

Guidelines for completion: Please refer to the criteria and state your reasons for nominating - no more than 500 words are allowed.

Additional Information