NOMINATION FORM
Fields marked with an asterisk indicate a required field. 

Only completed nominations will be accepted for consideration as determined by the nominations coordinator.  

To be considered for the upcoming induction year, submissions must be completed and accepted by January 1st.
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Email *
NOMINEE INFORMATION
Please select today's date: *
MM
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DD
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YYYY
Nominee First Name *
Nominee Last Name *
Is the Nominee deceased? *
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