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HALL OF FAME NOMINATION FORM

SEND TO: BELLEVILLE SPORTS HALL OF FAME
P.O. Box 20039, BELLEVILLE, ON K8N 4V1
Note: the more information you provide, the better

Please use additional sheets and staple to this form
Please attach, if available, newspaper clippings, letters of support and any other items you think are important.

1. Name of Nominee (in Full): ________________________________

2. Name of Nominator: _____________________________________

3. Nickname:______________________________________________

4. Place of Birth; __________________________________________

5. Date of Birth:___________________________________________

6. Current Address:________________________________________

7. Phone Number:_________________________________________

8. If deceased, when?: ____________________________________

9. Where?: ______________________________________________

10. Dates of residency in hastings or Prince Edward County:_________________________________________________

11. Family information, spouce's name: _______________________
Children (ages in brackets):_________________________________

12. Where educated (include public school, secondary schooL & post-secondary education)

 

13. Sport(s) in which nominee excelled:

 

14. Summary of outstanding contributions to sport:

 

15. SpeciaL awards, distinctions or citations bestowed on nominee (include dates):

 

16. Other information (or source of information) you consider important: