Central Chapter Nomination Form

This is a for which allows a member of the Central Chapter of the Pennsylvania Sports Hall of Fame to nominate someone to be honored.
If your are a member and want to nominate someone please print the form below, fill it out, & send it to:
Dennis Habecker, 637 North 11th Avenue, Lebanon, Pa 17046

If you questions about the process contact Dennis by a means shpwn below.
Tel. 717 272-5077
liftingliar@comcast.net

CENTRAL CHAPTER SPORTS HALL of FAME
(Induction Form for Nomination)

This form is submitted by ________________________________.
Member Name: _____________________________________________

Address:              _____________________________________________
City: ___________________________ State: ____________ Zip: ____________
Telephone: (H) ___-______- _______ (Cell) ____-_____-_______
Email:   ______________@________. _______ Date Submitted: ____/____/______
For more information about the Central Chapter Sports Hall of Fame go to:
www.centralchapter.org or https://www.facebook.com/search/top/?q=central%20chapter%20of%20pahof                        Revised 1/8/2016

This nomination is for the following: (Circle One)
Induction 2. Community Service Award 3. Courageous Athlete Award 4. Other

Part I : Personal Information of Nominee : CHECK ONE of these: LIVING ( ) or DECEASED ( )

Full Name __________________________________________________________

Address __________________________________________________________

City ________________________ State _________ Zip _____________

Telephone (H) ____-________-_________ (Cell) _____-_________-_____________

E-mail ____________@______________ or ______________@_______________

Part II: For Deceased Nominees Only:

Representative for deceased nominee: ___________________________________

Relationship to deceased nominee, i.e. spouse, son, daughter, niece, nephew, sister, etc.

_______________________________________________________________

Telephone no. for this representative: (H)____-_______- ________ (Cell) ___- _____- ______

Part III: Criterion for submitting this nomination

Must have met at least one of the following requirements;
Reached their 40th birthday.
Participated in the sport/ position at least 15 years.

Participation is determined on a case by case basis, as having competed, coached, administered, etc. in athletics or the business of athletics.

Retired from the sport/ position for at least two (2) years
Minimum of one (1) year from date of death is required for deceased nomination.

NOMINEE (LIVING) MUST ATTEND ANNUAL INDUCTION CEREMONY IF ELECTED. NAMED REP OF A DECEASED NOMINEE MUST ALSO ATTEND ANNUAL INDUCTION CEREMONY IF ELECTED.

Part V: Central Chapter Nominating Rights from these geographical areas:

Lebanon County
Hershey
Tulpehocken
Robesonia
Womelesdorf

We may on occasion nominate individuals outside these above listed geographic areas. In these cases we will contact and coordinate a nomination with the H of F Sports Chapter in question.

Part VI: Attached Glossy Picture and Information about this nominee.
Individual’s Information should include high school, college, Team, Years, Achievements, Records, Honors, Player… Please limit to 250-300 words

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