LSS 2018: NT Form

FieldMapping
Provide a mapping of fields that are too long to be captured in ExactTarget

Please select a category to nominate a Northern Territory based nominee:

Junior Sports Star Individual - This is awarded to athletes aged 18 years or under, that demonstrate the greatest achievement, dedication, fairness and sportsmanship. Nominees in this category must be competing at state level or above. Junior Sports Star Team - This is awarded to a team competing 18 years or under age group that is judged to have exhibited the greatest achievement, dedication, fairness and sportsmanship. Nominees in this category must be competing at state level or above. Young Sporting Spirit Individual - This is awarded to athletes aged 18 years or under, that demonstrate the greatest achievement, dedication, fairness and sportsmanship. Young Sporting Spirit Team - This award recognises a team competing in an 18 years or under age group that exhibits the greatest achievement, dedication, fairness and sportsmanship. Service to Sport - This is awarded to an individual club member or volunteer of a sporting organisation in their local community who shows the greatest level of passion, dedication and impact of contribution.

Full name of the nominee

Team Name

Sport
Please select the sport you are nominating for. If the sport is not here, please select other and type the sport.

Other Sport

Gender

Date of Birth of Nominee

Age Range of Team (DOB of Youngest and Oldest Team Members)
Please specify the date of birth for the youngest and oldest team players.

Nominee's email address

Nominee's Contact Number

Nominee's Address

Team name, club name and homeground
Only for Team Nominees

Coach or manager's name
Only for Team Nominees

Achievement
Please tell us about the nominees achievements and awards in their chosen sport.

Words left: 242/250

Dedication
Please tell us about the nominees dedication to their chosen sport.

Words left: 250/250

Fairness & Sportsmanship
Please tell us about the fairness and sportsmanship that the nominee displays in their chosen sport.

Words left: 250/250

Passion
Please tell us about the passion that the nominee displays in their chosen sport.

Words left: 250/250

Dedication
Please tell us about the nominees dedication to their chosen sport.

Words left: 250/250

Impact & Contribution
Please tell us about the impact and contribution the nominee has displayed within their chosen sport.

Words left: 250/250

Other supporting information
If there are multiple images or videos, please zip the files first. Videos must be under 2mins.

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Your full name

Relationship to the Nominee

If the nominee is Under 18, do you have the permission from the nominees Parent or Legal Guardian to nominate the individual?

Yes No

Your Contact Number

Your Email address

Your Address

How did you find out about the Local Sports Star program?

Parent/Guardian Name

Parent/Guardian Contact Number

Parent/Guardian Email Address

Parent/Guardian Postal Address

Coupon Code
Please enter a coupon code here if you received one at the Junior Sports Star challenge recently

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Please contact the parent or guardian of your nominee to ensure you have permission prior to submitting their nomination.