First Name: _____________________________
Last Name: _____________________________
Phone Number: ________________________
E-Mail Address: ________________________
Date Submitted: ________________________
If nominee is deceased, please provide a name, address, phone number or email address for a family member or other contact person.
High School and Year of Graduation: _______________________________________
College and Year of Graduation: ___________________________________________
On a separate typewritten page, list the significant accomplishments of the nominee, both as a Rockland County high school athlete or otherwise. Be as specific as possible. Include varsity letters earned, honors won (County, Section, State, etc.), records set, times/heights/distances, post-high school achievements, dates, etc.
If available, please submit a clear black-and-white or color photo (head shot) of the nominee.
First Name: ________________________________
Last Name: _________________________________
Phone Number: _________________________
E-Mail Address: _________________________
Please Submit to: Jamie Kempton
Chairman, Rockland County T&F Hall of Fame
55 Prospect St.
Nanuet, NY 10954