Wall of Fame Nomination Form
Justine Waldeck
Uncategorised
01 April 2022
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Wall of Fame Nomination 2025 (Submission deadline is May 1, 2025)
PLEASE READ THE ELIGIBILITY CRITERIA ON THE WEBPAGE PRIOR TO COMPLETING THIS FORM
Nominee's Full Name
Nickname (if applicable)
Current Address
Phone Number
Email
Place of Birth
If deceased, where/when?
Dates of residency in New Brunswick
Family Information
Partner's Name (if applicable)
Children's Names & Ages (if applicable)
Education
Public School
High School
Post Secondary Education (University/College)
Other Education
Work Experience
Job title(s), location(s), years
Nomination Category
Please select which category you are selecting for your nomination.
Athletic
Builders
Community Service
Summary of outstanding contribution in category nominated i.e. years of experience of service, in what capacity, at what level
Personal Attributes (please be specific)
Special Recognitions or awards
Other important information
Upload Photo of Individual to use on plaque (high quality resolution)
No file(s) selected
Upload other supporting documents (letters of support, news articles, etc).
No file(s) selected
Nominator Information
Your name (person making nomination)
Phone Number
Email
Today's Date
Select image of The Phone
Submit Nomination
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