Section 1: Nominee's personal background

Full Name*_________________________________Maiden Name__________________
Nickname_______________________________
Is nominee living?*_______ If yes, address*____________________________________________
______________________________________________________________________________
Date of Birth*__________________________ Place of Birth*______________________________
Date of Death*_________________________ Place of Death*______________________________
Name of Spouse________________________________Date of marriage_____________________
Children_________________________________________________________________________
High School attended*_____________________________ Years attended*____________________
College(s) attended*_______________________________ Years attended*___________________
Degree(s) received____________________________________
Military service________________________________________
Occupation__________________________________________
Religion_____________________________________________


* indicates a required field.

Section 2: Nominee's Hall of Fame Qualifications

List and attach on a separate sheet of paper all of the nominee's accomplishments, records, awards for which consideration should be made to be elected to the Hall of Fame, include complete playing, coaching, officiating or other criteria as it pertains to Ripley County basketball.

Section 3: Nominator's Information

Name______________________________________________________
Address________________________________________________________________________
Telephone________________________ Email____________________________________

Submit completed form to: