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 Telephone 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:
