Southlands All Stars Nomination Full Name of Nominee* First Last Date of Birth of Nominee* MM slash DD slash YYYY Gender of Nominee* Female Male Activity* 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 Guardian Other Permission 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*Max. file size: 50 MB.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 Δ
