EmailMe Form - 2024 Nomination Ballot

Nominator's WebSite
If Any (N/A if Unkown)

Nominator Active Member *

Name of Nominator *

Prefix First MI Last Suffix

Nominator's Martial Art
(only one) *

Address (Nominator)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Nominator Belt Color *

Nominator Classification *

Nominator Rank Number *

Nominator's Phone

### - ### - ####

Nominator's Email (If any)

Nominee's Website If Any

Nominee Active Member *

Name of Nominee *

Prefix First MI Last Suffix

Address (Nominee) *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Nominee's Age if under 18
If not known write UNK

Nominee's Martial Art
(only one) *

Nominee Belt Color *

Nominee Classification *

Nominee Rank Number *

Nomaniee's Phone

### - ### - ####

Nominee Email (If any)

Award Category *

Justification Required for Inspiration of the Year, Judith Nintai Award, Pioneer, Legends, HUmanitarian Award, Woman or Man of the Year
See qualifications on Hall of Fame Page on the webiste. *