Rhode Island Aquatic Hall of Fame Nomination Form

Full name:

Birth Date: Month: Month January February March April May June July August September October November December Day: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: Year 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

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Please check this box if this nomination is made posthumously

Nominee was a Rhode Island Resident from:   to

Please select affiliations with aquatics (more than one choice is acceptable: Competitive
                                                                                                             Coaching
                                                                                                             Water safety
                                                                                                             Official
                                                                                   

Please list major biographical data such as education, career milestones, achievement, awards, etc.
Please send documents to support the biographical information

Describe the qualities possessed by the nominee, which makes him or her worthy of consideration for induction:

Please list the name, address, and phone of an individual that would be able to provide information regarding the candidate:

   Full name:


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THIS FORM WAS SUBMITTED BY:

Full name:


Email:    

Phone:   

Address:

City:   State:   Zip: