Contribution to Physical Activity

To qualify for this award, the individual or group of must meet ONE of the following Qualification Criteria:

• Be born, live in and/or be based in County Durham
• Be able to show a significant connection to County Durham

To qualify for this award the individual or group must ALSO meet ONE of the following Nomination Criteria:

• Shown a long term commitment to developing physical activity opportunities in County Durham
• Made a significant difference to individuals/groups through physical activity in County Durham
• Demonstrated the positive impact physical activity can have on people's lives

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Nomination Details   CSN area for which the nomination is being made. Please select the appropriate box (ONE box only)   Chester le Street and Durham City Easington Teesdale and Wear Valley Derwentside Sedgefield   Name of Nominee (individual or group you are nominating)     Address (must be provided to allow contact)     Telephone (if known - important to allow contact)     Email Address (if known)   Reason for Nomination Please give details of the reason you are nominating this individual or group, highlighting how they specifically meet one/some/all elements of the Qualification and Nomination criteria in no more than 250 words. Details of person making the nomination   Name (your name)     Telephone number     Email address   Image   Please upload an image of the group/individual (for use in presentations)     Is the nominated person/group aware of this nomination?   Yes No      I nominate the above group/individual and confirm to the best of my knowledge the details given in support of this nomination are accurate. I understand the judges' decision is final and that no correspondence will be entered into. * If any of the details are found to be inaccurate or false this will result in your nomination being withdrawn from the process.   Type both words separated by a space below:

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