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Hall of Fame Nomination Form

Name of Nominee *

First

Last
Graduation Date *

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Nominee's Current Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Nominee's phone number

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Nominee's Email
Name of Nominator *

First

Last
Nominator's Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Nominator's Phone number *

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Nominator's Email *
Category of Nominee *
 Athlete 
 Coach 
Please type a description of the nominee's accomplishments related to Eureka High School. You should include any achievements the nominees attained while attending Eureka High. For example special honors, league and school records, all-star awards, etc. *
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Web site origanaly created by: Carruth Topham
Last edited by: Carruth Topham
Last edited on: 10 June 2011