252-240-7424 (ONE NOMINATION PER FORM) | |||
NOMINEE INFORMATION: (Please Print) NAME:_____________________________________________________________________________ (*Required Field - Please Print Clearly) ADDRESS:__________________________________________________________________________ (*Required Field - Please Print Clearly) PHONE NUMBER:___________________________________________________________________ (*Required Field - Please Print Clearly) E-MAIL ADDRESS:__________________________________________________________________ (*Required Field - Please Print Clearly) | |||
Name of Nominator/Year of Induction:____________________________________________________ | (Please Print Clearly All Nominator Information, Except Signature) Address of Nominator:_________________________________________________________________ Phone Number/Email Address:___________________________________________________________ Signature of Hall of Fame member:_____________________________________Date:______________
The below listed criteria in support of this nomination must be provided in order for an
individual to be
It is the responsibility of the Hall of Fame member making the nomination to discuss with the
*** This application is for consideration only and DOES NOT GUARANTEE INDUCTION
SUPPORTING DOCUMENTATION: ____________________________________________________________________________________ ____________________________________________________________________________________
____________________________________________________________________________________ (Rev.3/2013) | |