Selected Community Selected Community AfricvilleAmherstAntigonishBear RiverBear RiverBeechville (Beech Hill)Birchtown (Annapolis Valley)Birchtown (Guysborough)Birchtown (Shelburne)BoylstonBridgetown/InglewoodBrindley TownCherry Brook-Lake LoonDartmouth (Crichton Av., Prince Albert Rd.)Digby (Acaciaville, Conway)North PrestonEast PrestonFall RiverGlace Bay (The Sterling)Guysborough RdHantsportHalifax (northend)JogginsKentville (Aldershot, Gibson Woods, Sheffield Mills)LequilleLincolnvilleLiverpoolLucasvilleManchesterMonastery (Rear Monastery)MulgraveNew GlasgowNew WaterfordSackville (Cobequid Rd, Maroon Hill)Shelburne (Birchtown, Port La Tour)SpringhillSunnyvilleSydney (Whitney Pier)TruroUpper Big TracadieUpper Hammonds Plains (Pockwock)Weymouth (Danvers, Hassett, Southville, Weymouth Falls)Weymouth (Danvers, Hassett, Southville, Weymouth Falls)Yarmouth (Greenville, Pleasant Lake)

Name of Team

Team Mailing Address

Team Email Address

Team Phone Number

Team members (list all by name). Up to 5 person team with at least one team member having a provable significant connection selected community (ancestral or family connection, current or former residence, long term social association, work related.

Main Contact Person

Second Contact

Name of team member(s) with connection to selected community and description of that connection:

Name (one only) of team member or Team Bank account number (Name of Bank, Address, Account, Transit #)

Indicate reason for entering competition

Have you read all competition rules and regulations? Have you read all competition rules and regulations? Yes No