City of Hampton, The Athletic Hall of Fame of the Lower Virginia Peninsula

The Athletic Hall of Fame of the Lower Virginia Peninsula Nomination Ballot

I wish to nominate the following person for the Athletic Hall of Fame of the Lower Virginia Peninsula:
(Authenticated biographical sketch and any other information of your choice must be included in the comments field of this form.)

Fields marked with an asterisk * are required.

General Information
Name:
Address:
City:	State: Zip:
E-mail Address:
Phone Number:
Date and Place of Birth (mm/dd/yyyy):
Next of Kin if Deceased
Name:
Address:
High School Attended
Name:
Address:
College Attended
Name:
Address:
Position Played:
High School, College or Professional Record & Honors:
Present Occupation:
Nomination Submitted By
Name:
Address:
*E-mail Address:
Comments: