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2. I wish to nominate the following person for the Athletic Hall of Fame of the Lower Virginia Peninsula: (Authenticated biographical sketch and any other information of your choice must be included in the comments field of this form.)
   
   Fields marked with an asterisk * are required.
4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Email
17. Contact Number
19. Date and Place of Birth
23. Next of Kin if Deceased
25. First Name
26. Last Name
28. Address1
30. Address2
32. City
33. State
34. Zip
38. Name of High School Attended:
40. Address of High School
44. Name of College Attended:
46. Address of College:
48. Position Played:
50. High School, College or Professional Record & Honors:
52. Present Occupation:
54. Attachment #1:
    Provide any documentation that you feel would be helpful for this nomination.
56. Attachment #2:
    Provide any documentation that you feel would be helpful for this nomination.
60. Nomination Submitted By
62. First Name
63. Last Name
65. Address1
67. Address2
69. City
70. State
71. Zip
73. Email Address:*
75. Comments:
Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit Submit and Print

* indicates a required field