(Use the mouse to create your signature)
If it's not possible to obtain an electronic signature from the SSO, please get the SSO to send a short endorsement email to email@example.com .(Only required if the nominating organisation is not the SSO who is a member of Sport SA).
The Sport SA Country Athlete of the Year is a resident in the country regions of South Australia who has achieved outstanding sporting success in SA country competitions.
A country competition is defined as events centred outside the areas defined by SA Government as Adelaide and Adelaide Hills.
Please refer to the copy of the SA Government map shown below. The metropolitan areas are shaded in lime green (Northern Adelaide), beige (Adelaide Hills) and blue (Southern Adelaide). Western and Eastern Adelaide are obscured by the road lines.
Country Areas are defined as those areas shaded in purple (Barossa), pale green (Murray and Mallee) and pale grey (Fleurieu and Kangaroo Island) and all areas further from the Adelaide Metropolitan areas (Limestone Coast, Yorke and Mid North, Far North and Eyre and Western).
List the nominated persons sporting acheivements for the 12 month period only, 24th August 2016 to 23rd August 2017 (selection will be based on this information):
For promotional purposes, please summarise the Nominee’s acheivements and results in 60 words or less (restricted to the last 12 months only). Please also send a recent photograph (head and shoulders with clean background or action shot, electronic high resolution to firstname.lastname@example.org) of the Nominee for promotional purposes (this information will be used at any announcement / presentation functions).
In signing this nomination, I acknowledge that the nominee for Country Athlete of the Year abides by our own sports code of conduct.
Notes: (1) Organisation must be a member of Sport SA, or a club affiliated with a Sport SA member. Club nominations must be endorsed by the State Sporting Organisation (who is a member of Sport SA).
(2) Only required if the nominating organisation is not the State Sporting Organisation.
Nominations close 5pm 23rd August 2017. Late entries will not be considered.
2017 Country Athlete of the Year Award
Proudly sponsored by Statewide Super