Individual Nomination Name of Nominee * First Name Last Name Date of Birth MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Classification * Player Builder Player/Builder Achievements Contributions Other Sports Involvement Submitted by Name * First Name Last Name Phone (###) ### #### Email Nominations will be sent via email to Murray Zuk. If you have any questions, contact MBHOF office at 204-822-4636 Nominations can also be sent to Box 158 Souris, MB. R0K 2C0 Thank you!
