EmailMe Form - State Hall of Fame Nomination Form

Nominee Name

First Middle Last

Nominee Current Address

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

Nominee Daytime Phone

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

Nominee Evening Phone

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

Nominee Email Address

Confirm

Born in Washington State

Yes

No

If not born in Washington State, where?

Washington State Residency From:

MM / DD / YYYY

Washington State Residency To:

MM / DD / YYYY

Nominee Date of Birth

MM / DD / YYYY

Nominee Status

Living

Deceased

If Deceased, Date of Death

MM / DD / YYYY

If Deceased, Name of Closest Living Relative

First Last

Family Relationship

Address of Living Relative

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

High School Attended by Nominee

City and State

Year Graduated

College Attended by Nominee

City and State

Year Graduated

Category of Nomination

If you selected "Sport" for the Category, please list name of sport here

Nominee Performance(s) for Consideration

List performance(s) of the Nominee in chronological order in the box above.

Action Photo Upload

Provide a high resolution (300 dpi) action photo of the Nominee. Max. file size is 1mg.

Headshot Photo Upload

Provide a high resolution (300 dpi) head shot photo of the Nominee. Max. file size is 1mg.

Nominator Information

Your Name

First Last

Address

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

Email

Date of Nomination

MM / DD / YYYY