Maccabi Victoria

Individual Award Nomination Form

Outstanding Maccabi Club Junior Sportsman of the Year

Outstanding Maccabi Club Junior Sportswoman of the Year

Outstanding Maccabi Club Sportsman of the Year

Outstanding Maccabi Club Sportswoman of the Year

Outstanding Maccabi Club Masters Sportsman of the Year

Outstanding Maccabi Club Masters Sportswoman of the Year

Outstanding Jewish Junior Sportsman of the Year

Outstanding Jewish Junior Sportswoman of the Year

Outstanding Jewish Sportsman of the Year

Outstanding Jewish Sportswoman of the Year

Outstanding Jewish Masters Sportsman of the Year

Outstanding Jewish Masters Sportswoman of the Year

NOMINATION PROCESS & CHECKLIST

To ensure your Nomination is valid, please tick and include each of the following in the nomination:

Nomination is from a Maccabi Victoria club, (If there are any difficulties in securing the nomination from your club, please submit your nomination anyway and our Search Committee will contact your club on your behalf.)

A nominee may be nominated in respect of more than one sport

Nominee is a current financial member of the nominating Maccabi club. Those nominees competing for non-Maccabi Victoria Clubs are onlyeligible if it is deemed that they are playing at a significantly higher level for that other club than the level which is available within the Maccabi club of that sport.

List of nominee’s performances, achievements, records and level of competition over the period 1 January 2012 – 31 December 2012

Performance verification completed by Club and /or Association.

Non Maccabi Club member – verification of play at significantly higher level than offered by Maccabi club

Junior sportspersons are under 18 on the 31 December 2012.

Digital photo (head and Shoulders) and at least 3 action photos to be supplied with Nomination Form . (Note: photos 300 dpi jpeg minimum)

Nomination to be received by Maccabi Victoria Office (by close of business, Thursday, 28 March 2013.)

Attention: Jacquie Lerner

9563 5885

NOMINEE INFORMATION
NAME: / DATE OF BIRTH:
HOME ADDRESS:
SUBURB: / POSTCODE:
HOME PHONE: / MOBILE:
EMAIL:
NOMINATOR INFORMATION
CLUB:
CLUB CONTACT:
HOME ADDRESS:
SUBURB: / POSTCODE:
HOME PHONE: / MOBILE:
EMAIL:

NOMINEE’S SPORTING RECORD FOR THE YEAR 1 January 2012 – 31 December 2012:

Please include the name and date of the events, performances, placings, awards eg VPSSA State Championships, 100m, 13.3 seconds, First place

CLUB ACHIEVEMENTS
STATE ACHIEVEMENTS
NATIONAL ACHIEVEMENTS
INTERNATIONAL ACHIEVEMENTS
CURRENT RANKING (if applicable)

NOMINEE’S BACKGROUND ( max. 200 words)

  • Describe in brief the nominee’s Club, State, National, International (where applicable), l performances which led to this nomination.(Please provide verifications – website links/letters etc) for achievements listed.)
  • Excerpts from this background will be used at the Awards function, so please ensure information is precise and accurate.

ENDORSEMENT OF NOMINATION

These endorsements are required as evidence of broad support for the nominee’s achievements

1.Club President

I attest that, to the best of my knowledge, the information provided regarding this nominee is both fair and accurate.

Name:………………………………………………………………

Signature:………………………Phone: …………………………………………

  1. Governing Sports Association (if applicable)

As the State Sports Association representative most familiar with the nominee’s achievements, I attest that to the best of my knowledge, the nominee is worthy of this Award and that the information is both fair and accurate.

Name:……………………………………Status:……………………………………

Signature:……………………….Phone: …………………………………..

  1. Nominee Declaration

I, ………………………………………………., the nominee, have read and understand the nomination procedures listed on the this official nomination form and I agree to abide by the conditions.

Signature of Nominee …………………………………………………………… Date ……………………………………………………………………

  1. Parent/Guardian Declaration (Junior Awards Only)

I agree to ……………………………………………………… (nominee’s name) being photographed or filmed for the Macabi Victoria Sports Awards publicity purposes

Name:……………………………………………………………….

Signature:……………………………………………………………….

Relationship::……………………………………………………………….

Maccabi Victoria Individual Nomination Form 2012