Inductee Information Form
Please complete the relevant parts of this form.
Yes, I will be attending the Induction Luncheon and Ceremony. (please check one)
*
YES, I will be there.
No, I will not be attending.
GENERAL INFORMATION
Name
*
First Name
Last Name
Nickname
Current Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
CAREER INFORMATION
Present Position
Employer
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Retired from
Year
List newspapers for publicity purposes.
EDUCATION
High School
Year Graduated
College
Year Graduated
Major/Degree
Other Colleges attended?
EXPERIENCE - High School Playing/Coaching
Years - High School Position - Records/Championships
High School Statistics
PPG - RPG - TOT.PTS - ASSISTS - STEALS - RECORDS SET
Other High School Sports Played
Sport, Years, Position, Records/Championships
High School Awards/Honors
Athletic/Academic/Awards/Recognition /Records
EXPERIENCE - College Playing/Coaching
Years - College Position - Records/Championships
College Playing/Coaching Statistics
PPG - RPG - TOT.PTS - ASSISTS - STEALS - RECORDS SET
Other College Sports Played
Sport, Years, Position, Records/Championships
College Awards/Honors
Athletic/Academic/Awards/Recognition /Records
Other Basketball Playing/Coaching Experience
AAU, International, etc. /Organization, Position, Years
REFEREES
General Information
Organizations, Year
Positions Held
Organizations, Year
Refereeing Experience
Where, years... Tournaments/Championships, Honors
CIVIC/SOCIAL INFORMATION
Honors/Awards/Committees/Memberships?
Organization - Position - Year
Hobbies and/or Recreational Interests?
Special places your teams have traveled?
Parents/Siblings/Relatives who have participated in Basketball?
Relative, Where played, Year
Why is basketball special to you?
How did you get interested in basketball?
Who had the greatest influence in your career?
Explain a BASKETBALL EVENT that was your fondest moment or memory.
Victory, Honor, Award, etc.
If you could change ONE basketball rule, what would it be?
What ONE piece of advice would you like to give to young players, coaches, or referees?
Do you have personal goals in basketball?
WHO WILL PRESENT YOUR AWARD?
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship to you?
Parent, Coach, Friend, Neighbor, etc.
Why have you chosen this person?
Tell us something special about them that we can use in their introduction.
Any other information about your life and/or career that we have forgotten to ask?
Please verify that you are human
*
Submit Your Information
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