Nominate Your School's Sports Hero

Nominated Sports Person

First Name:

Last name:

Date of Birth:

Gender: Male Female

Email:

Street Address:

Suburb:

City:

Phone:

School:

Region:

Sports Participated In:

Attach Supporting Photo:

Other Sport(s) if any:

Outline of Sporting Achievements in Last 6 Months:

Outline any Hardship or Disability he/she has had to Overcome:

Nominated By

First name:

Last name:

Date of Birth:

Gender: Male Female

Street Address:

Suburb:

City:

Phone:

Email:

Sign me up to the ASICS New Zealand Newsletter:

Teacher’s/ Coach’s Endorsement

First name:

Last name:

Phone:

Email:

Nominate!

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