Fall of Fame Nomination Form - McBain Rural Agricultural School

McBain Ramblers Athletic Hall of Fame Nomination Form

PLEASE CHECK APPROPRIATE NOMINATION CATEGORY(IES): You can be in all (3)

Student Athlete

Coach

Contributor

Name

First Name

Last Name

Phone Number

Email Address

Address

City

State/Province

Zip/Postal

Address

Years of High School at McBain

College/University Attended

College/University Years Attended

Military Branch

Military Years Served

Is Nominee still Living?

Yes

Please provide date of passing

Name of Spouse or Next Living Relative

Address

City

State/Province

Zip/Postal

Address

Email Address

Phone Number

First Name

Last Name

Address

City

State/Province

Zip/Postal

Address

Relationship to Nominee

Phone Number

Email Address

Signature