MHSAA Hall of Fame

Nomination for Induction

as Builder, Athlete or Team
I/we hereby nominate* for induction into the Manitoba High School Hall of Fame in the category of:
AthleteBuilderTeam
in the following sport(s):*

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Town/CityPostal Code

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It is understood that the final selection process is the sole responsibility of the Manitoba High Schools Athletic Association or the designates, and they they will verify that the nominee is eligible for nomination as outlined in the official criteria established.

NOTE: Please ensure that all the information below is completed.
Nominator
Name:*

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Town/CityPostal Code

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Signature:*

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Home Address:*

Street Address/Box #

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Town/CityPostal Code

Postal / Zip Code
Phone Number:*
Email:*
Nominee

(If deceased, please also list next of kin)
Name:*

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Town/CityPostal Code

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Home Address:*

Street Address/Box #

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Town/CityPostal Code

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Phone Number:*
Email:*
Maiden Name (if applicable):

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Date of Birth*

MonthDayYear
Date of Death (if applicable)

MonthDayYear
Name (next of kin):

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Town/CityPostal Code

Postal / Zip Code
Home Address:

Street Address/Box #

Street Address Line 2

Town/CityPostal Code

Postal / Zip Code
Phone Number:
Email:
Summary of Sports Career:
Dates, awards, records etc. are important. Please give as much information as possible. A breakdown of conference/league, zone, provincial and other accomplishments in chronological order is preferred. Please provide information on both their high school career and career beyond that at the university/college, national and/or world competitions, etc.).
High School Accomplishments:*
University/College Accomplishments:*
National/International Accomplishments: *
Professional Accomplishments:*
Other (Awards, other hall of fame inductions, etc.):*
Please include supporting documentation (news clippings, copies of certificates, awards, etc.):

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Please include a picture of the nominee, preferably one from the time they are being nominated:

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Should be Empty:

Nomination for Induction

Nominator

Nominee

Summary of Sports Career: