Wall of Fame Nomination Form

Justine Waldeck Uncategorised 01 April 2022 Hits: 23275

Nominee's Full Name

Nickname (if applicable)

Current Address

Phone Number

Place of Birth

If deceased, where/when?

Dates of residency in New Brunswick

Partner's Name (if applicable)

Children's Names & Ages (if applicable)

Public School

High School

Post Secondary Education (University/College)

Other Education

Job title(s), location(s), years

Please select which category you are selecting for your nomination.

Athletic

Builders

Community Service

Summary of outstanding contribution in category nominated i.e. years of experience of service, in what capacity, at what level

Personal Attributes (please be specific)

Special Recognitions or awards

Other important information

Upload Photo of Individual to use on plaque (high quality resolution)

No file(s) selected

Upload other supporting documents (letters of support, news articles, etc).

No file(s) selected

Your name (person making nomination)

Phone Number

Today's Date

Select image of The Moon

Wall of Fame Nomination 2026 (Submission deadline is May 1, 2026)