Name of Nominee

    First Name: *

    Last Name: *

    Date of Birth:

    Address:

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    Postal Code:

    Phone Number:

    Email Address:

    Classification

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    Achievements

    Contributions

    Other Sports Involvement

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    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