SUFFOLK SPORTS HALL OF FAME
                     EDUCATIONAL CENTER & MUSEUM

                        NOMINATION FORM FOR PROSPECTIVE INDUCTEES

                                                                                 Date Submitted: ____________
Nominee: _______________________________________
Phone #: _____________________    D.O.B.: _____________________
Current Address: __________________________________________________________
Business Address & Phone: ________________________________________________
Cell #: _______________________    Fax: ___________________

This form and all correspondence, including the 3 letters of recommendation
(as required below), must be typewritten or computer typed for submission.

The following items are required at the time of submitting this nomination:
           1. A biography of the nominee (in chronological order).
           2. An 11 x 14 photograph of the nominee (preferably in uniform or "in action"
               for respective sport)
           3. Any news or media reports or any publications written about the nominee
           4. Copies of any certificates, awards, proclamations, etc. relative to the
               nominee's participation in his/her respective sport
           5. Copies of any awards for "Community Service"
           6. Copies of any internet information on the nominee's sports career or
               community involvement
           7. Three (3) letters of recommendation from non-family members in support
               of this nomination
           8. Any available video, CD or DVD publications of nominee 

Nominated by:
              Name: ____________________________________________
           Address: ____________________________________________________
              Phone: ________________ Cell Phone: ________________  
Business Name: _____________________________________________  
             Phone: ________________    Fax: ___________________

All material submitted must be enclosed in a bound or binder book form or 
professionally enclosed by fastener in a file type folder. Nominations that
do not contain each and every one of the above requirements will not be 
accepted by the SSHOF.

Please refer to the "QUALIFICATIONS FOR A PROSPECTIVE INDUCTEE" 
(click link) for guidelines in makeing yor nomiations.

ALL NOMINATIONS, IN COMPLETE FORM, WILL BE ACCEPTED BY THE
SSHOF BEGINNING ON JUNE 1st OF EACH YEAR COMPLETED 
APPLICATIONS MUST BE RECEIVED BY THE SSHOF BY THE END OF
THE BUSNESS DAY OF SEPTEMBER 15th OF EACH YEAR. 

RETURN THIS COMPLETED FORM AND ALL REQUIRED INFORMATION TO:
                                  SUFFOLK SPORTS HALLOF FAME
                62 SOUTH OCEAN AVENUE, PATCHOGUE, N.Y. 11772
                                         PHONE # 631-758-7463

TO BE COMPLETED BY THE SSHOF
****************************************************************************************************************************************
Date received by the SSHOF: ___________________________

Received by: ____________________________________ ___________________
                      Printed Name                                                    Signature

         DATE OF VOTE: __________________ 
 RESULTS OF VOTE:   ___ACCEPTED: ___________
                                        NOT ACCEPTED: ______

VALIDATED BY: ___________________________________
           ________________Edward J. Morris, SSHOF Executive Director