Nomination Form

Date of Nomination

Nominee’s Name

Nominee’s Date of Birth

Nominee’s Date of Death (if applicable)

Submitter’s Name

Submitter’s Title/Occupation

Submitter’s Affiliation/Association to Nominee

Submitter’s Address


E-mail Address

Categories (Please check all that apply) PlayerPillarTeam

Please provide essential biographical information about the nominee:

Please describe in what ways the nominee’s accomplishments and/or contributions have been of great value to the game of hockey:

Please describe the significant local, national or global impact of the nominee’s achievements:

Please list nominee’s awards, achievements & honors:

Please list sources of information:

Attach any supporting articles, photos, etc. here: