The 2009 Induction Banquet will be held on January 21, 2010 at the Firefighters' Banquet Hall, on Bonsor Street, adjacent to The Bay in MetroTown. Map to Banquet Hall   BSHoF	Burnaby Sports Hall of Fame located in the: Bill Copeland Sports Centre 3676 Kensington Avenue, Burnaby BC, V5B 4Z6 General inquiries: 604-294-7450   Application Form (return by October 02, 2009 deadline)

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NOMINATION FORM Nomine name:___________________________________________________ Address:________________________________________________________ Phone:____________Cel:____________E-mail:_________________________ Category: ______Athlete ______Coach ______Builder ______Team Sport(s):________________________________________________________ List Accomplishments: (Attach supporting documents)     For a printable version of this form, please click here  .       Nominated by:____________________________________________________ Address:________________________________________________________ Phone:____________Cel:____________E-mail:_________________________ Signature:____________________________________Date:_______________ Send Nomination Form to:   Nomination c/o Burnaby Parks, Recreation and Cultural Services, #101 - 4946 Canada Way, Burnaby, B. C. V5G 4H7

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