Inductee Nomination - Adams County Sports Hall of Fame

Nomination Form for Induction

Nomination form for induction into Adams County Chapter Pennsylvania Sports Hall of Fame

Note: Progress my not be saved if you leave this page. For best results prepare your information in an offline document then copy/paste the information here when ready to be submitted.

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Part I: Nominee’s Personal Information

Nominee's Name

First

Last

Nominee's Nickname (if any)

Nominee's Address

Address Line 1

Address Line 2

City

State

Zip Code

Nominee's Date of Birth

Nominee's Phone

Nominee's Email

Part II: If Nominee is deceased

Date of Death

Nearest Family Member Name

First

Last

Nearest Family Member Address

Address Line 1

Address Line 2

City

State

Zip Code

Nearest Family Member Phone

Nearest Family Member Email

Part III: Education

List all know education and dates of the Nominee

Part IV: Sports Participation/Achievements

List all known sports participations/achievements of the Nominee (copy)

Part V: Coaching Career (if applicable)

List all known coaching involvement of the Nominee

Nominee's List Member

Part VI: Family

List all known immediate family members of the Nominee

Part VII: Community Involvement

List all known community involvement of the Nominee (copy)

Part VII: Additional Comments

Add any addtional comments

Part IX: Contact Person (if more information is needed)

Name of Contact Person

First

Last

Address of Contact Person

Address Line 1

Address Line 2

City

State

Zip Code

Phone of Contact Person

Email of Contact Person