Southlands All Stars Nomination Full Name of Nominee* First Last Date of Birth of Nominee* Gender of Nominee*FemaleMaleActivity* Sporting Achievement Creative and Performing Arts Other Other Activity*Sporting Group, School or Association the nomination is based on*Nominee's Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Nominee's Contact Number*Nominee's Email* History of DedicationNotable Achievements*Future Aspirations*Reasons for Nomination*Full Name of Nominator* First Last Relationship to Nominee*Parent or Legal GuardianOtherPermission from Parent/Legal Guardian* I have permission from Nominee's Parent/Legal Guardian to submit this Nomination Nominator's Contact Number*Nominator's Email* Upload an image of the Nominee*Permission to Upload Image* I have permission to upload Nominee's Photo How did you find out about the Southlands All Stars Promotion?*Promotion Terms & Conditions* I have read & accept the Terms & Conditions
