Official Nomination Ballot

(2022 Deadline is end of business on December 1, 2022)

Nominee Name

First Name Middle Name Last Name

Nominee Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Nominee Daytime Phone

Please enter a valid phone number.

Nominee Evening Phone

Please enter a valid phone number.

Nominee Email Address

example@example.com

Born in Hawaii

Yes No

If not born in Hawaii, where?

Hawaii Residency

From (year) to (year)

Nominee Date of Birth

Date

Status

Living Deceased

If Deceased, Date of Death

If Deceased, Name of Closest Living Relative

Family Relationship (Son, Daughter, etc.)

Address of Living Relative

Street Address

Street Address Line 2

City State / Zip Code

Phone Number

High School Attended by Nominee

Year Graduated

College Attended by Nominee

Year Graduated

Category of Nomination

World Champion World Record Holder Olympic Medalist Contributor Pioneer Other

If needed, please provide additional information or elaborate on your choice:

Nominee Performance(s) Being Considered for Nomination

1. List performance(s) of the Nominee in chronological order in the box below.
2. Provide supporting documentation (clippings, etc.) by attaching below.
3. Provide a non-returnable action photo of the Nominee by attaching below.

Uploading Supporting Documentation (clippings, photos, etc.)

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Nominated by:

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Daytime Phone

Please enter a valid phone number.

Evening Phone

Please enter a valid phone number.

Email

example@example.com

Relationship to Nominee

Signature

Clear

Date of Nomination

Date

Criteria for nomination can be found on the Hawai'i Sports Hall of Fame website at this address: hawaiisportshalloffame.com/selection-criteria.html

Individual accomplishments of current Hall of Fame members are available on our website.

You can submit this form electronically by clickiing on the SUBMIT button below - or - you can PRINT the form and send with supporting documentation (if any) to this address:

Hawai'i Sports Hall of Fame
PO Box 201417
Honolulu, HI 96820-1355