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Civic Sport Merit and Arts and Culture Merit Awards Application Form

Have you brought Provincial, Western Canadian, National or International recognition to Nanaimo? Let us congratulate you!

Nanaimo City Council presents certificates of congratulations and medallions to all individuals, groups, teams and clubs who have brought recognition for outstanding achievement in sports or arts and culture on a Provincial, Western Canadian, National or International level to our city by placing FIRST or achieving highest standing in their field of endeavor. Award recipients must be residents of Nanaimo.

Fall/Winter medal ceremony will be on October 21, 2024.

Before you begin, please have all information for the event (dates, location, name, address) and a complete list of first and last names of all athletes/performers (including group leaders, crew, coaches and team managers). All applicants must be residents of the City of Nanaimo. Please ensure the form is completed fully and before being submitted. If you have any questions, please email awards@nanaimo.ca.

Deadline for award: September 16, 2024

Is this application for

Level of Achievement

YEAR/MO/DD

If recipients completed in different age categories, please provide in column where recipient information is collected below.

An example "2023 U-16 Provincial Championship"

Contact Person Information

 

IMPORTANT: This person will also be responsible for relaying award ceremony information to all group/team members.

Let us know if there is any other information we need to know about the Contact Person.

Names and Information for Award Recipients

Please provide the recipient information here. Names will appear on certificates as submitted on this form. PLEASE ENSURE SPELLING IS CORRECT.

If you are submitting more than 20 recipient names, please contact awards@nanaimo.ca for instructions on how to submit additional names.

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Please organize information in the following order: FIRST NAME/LAST NAME/AGE CATEGORY/EVENT/STREET ADDRESS

Questions? Please contact us at awards@nanaimo.ca. Application must be submitted by September 16, 2024 to be included in the October 21, 2024 awards ceremony.

Applicant's Acknowledgement

Acknowledgement

Collection and use of your personal information

Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA) and is protected in accordance with FOIPPA. Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose. Questions about the collection of your personal information may be referred to the Legislative Services Department at 250-755-4405, or via email at foi@nanaimo.ca. Please also see our Privacy Policy.

Last updated: November 14, 2024

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Collection and use of your personal information

Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA) and is protected in accordance with FOIPPA. Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose. Questions about the collection of your personal information may be referred to the Legislative Services Department at 250-755-4405, or via email at foi@nanaimo.ca. Please also see our Privacy Policy.