Fall of Fame Nomination Form - McBain Rural Agricultural School

McBain Ramblers Athletic Hall of Fame Nomination Form

Please Check Appropriate Nomination Category. Note 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