Mackay Sporting Hall of Fame nomination form

Please complete the following information to nominate a person for inclusion in the Mackay Sporting Hall of Fame. Note: Self nominations are also accepted.

Nominee contact details (or family representative if nominee is deceased)

Full name
Address
Suburb
State
Post code
Email address
Contact number

Nominee details

Nomination type
Sport/s
Australian citizen	Yes No
Date of birth
Age
Place of birth
How long has/did the nominee reside/d in Mackay?
Did the nominee attend school in Mackay?	Yes No
If yes, which school(s)
Which club/s did the nominee play/lead/coach/officiate for in Mackay?
Where did the nominee complete most of their development in their chosen sport?
What is the nominee’s highest level of competition achieved?
Please list all achievements of the nominee with year and name of competition
Please upload a statement from governing body/association/or club confirming athlete resided in Mackay whilst forming their athletic career, and level of achievements attained in their sport.
Does the nominee demonstrate exemplary integrity, sportspersonship and character? Please detail examples:
Is the nominee now retired from sport?	Yes No
If yes, how long for?

Supporting documentation (Optional)

Letters of support from club and/or community members:
Newspaper articles and media releases:

Nominator declaration

To the best of my knowledge, all information provided in the nomination form is true and correct. • I understand that the application and any material accompanying the application will not be returned

I agree
I disagree

Nominator details

Full name
Address
Suburb
State
Postcode
Email address
Contact number
Relationship to nominee

Privacy Statement: Mackay Regional Council is collecting your and the nominee’s information in order to process the nomination. This information will only be disclosed to any other third party with your written authorisation or as required by law.