Nomination Form – Maritime Motorsports Hall of Fame

maritimemotorsports@gmail.com

+1 506 756 2110

5 Hooper Lane, Petitcodiac, NB

PDF version – view, print, or download for hard copy submissions.

Online Nomination Form

Nominee Information

Nominee's Full Name *

First

Middle

Last

Nickname (if any)

Place of Birth *

please include province/state and locality

Date of Birth *

Current Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Daytime Phone Number *

Mobile Phone Number

Email *

Email

Confirm Email

Is Nominee Deceased

No
Yes

Address for Next of Kin *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Motorsports Career Information

Category of Nomination *

please refer to Selection Process for complete descriptions of category inclusions

If retired from motorsports, what was the last year of participation?

Competition and Achievement (50 Points) *

Other Awards and Recognition

Achieving Success (25 Points) *

Consistency of Achievements (15 Points) *

Photograph of Nominee *

Click or drag a file to this area to upload.

please submit a high-resolution 5" x 7" or 8" x 10" photograph of the nominee - MUST BE INCLUDED WITH THE NOMINATION

Other Support Materials

Click or drag a file to this area to upload.

Include (a) letters of support, (b) newspaper articles, (c) websites with information, (d) copies of award certificates, citations, any other pertinent information. (Must be file types PDF, JPG, or DOC)

File Upload

Click or drag a file to this area to upload.

File Upload

Click or drag a file to this area to upload.

File Upload

Click or drag a file to this area to upload.

File Upload

Click or drag a file to this area to upload.

Website / URL

Website / URL (copy)

Nominator Information

Name *

First

Middle

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Daytime Phone Number *

Mobile Phone Number

Email *

Email

Confirm Email

Declaration *

I HEREBY DECLARE THAT TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE INFORMATION IS ACCURATE AND CORRECT.

Captcha *

=

if you see a * in the equation it means to multiply

Form Completed By *

First

Middle

Last

Your nomination will be processed when you click submit. Please be patient while processing and do not resubmit or terminate. A successful order will result in a thank-you message and receipt of an email showing your nomination. If there are errors in your submission they will be indicated on the form - correct and resubmit.

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