Kenpo International Hall of Fame
Sustaining Member Nomination Form
Please submit a separate form for each nominee
Nominee Full Name
*
First Name
Last Name
Martial Arts Style
*
System/Organization
*
If no organization, enter "none"
School Name
*
Nominee's Current Rank
*
Reason for Nomination
*
Please provide contact information for the Nominee.
Nominee's E-mail
*
Nominee's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Other Phone Number
-
Area Code
Phone Number
Nominee's Website url
http://www.example.com
Who is submitting this nomination?
Your Full Name
*
First Name
Last Name
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Phone Number
*
-
Area Code
Phone Number
Your e-mail
*
example@example.com
Your Martial Arts Style
*
Your Martial Arts System/Organization
*
Relationship to Nominee
*
I am the nominee's instructor.
I am a student of the nominee.
I have attended seminars taught by the nominee.
I am a friend of the nominee.
I train/trained with the nominee.
Other
Please provide a short biography of the nominee.
We will read this as they are inducted.
Bio
*
Comments (please provide any additional relevant information)
Submit Form
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