Individual Nomination

    Name of Nominee

    First Name: *

    Last Name: *

    Date of Birth:

    Address:

    City: *  Province: *

    Postal Code:

    Phone Number:

    Email Address:

    Classification

    Choose one: *

    Achievements

    Contributions

    Other Sports Involvement

    Submitted by

    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