DUSTOFF ASSOCIATION

P.O. Box 8091, Wainwright Station, San Antonio, TX 78208

 

DUSTOFF HALL OF FAME NOMINATION FORM

1.     About the Nominee

Name of the Nominee

Social Security Number

     

     -      -      

Address of the Nominee

     

City

State

Zip Code

     

     

     

Nominee’s Commercial Phone No.

Nominee’s Commercial Fax No.

Nominee’s E-Mail Address

(      )      -      

(     )      -     

     @     

2.     About the Nominator

Name of the Nominator

Date  (mm/dd/yy)

     

     /      /      

Address of the Nominator

     

City

State

Zip Code

     

     

     

Nominator’s Commercial Phone Number

Nominator’s Commercial Fax Number

Nominator’s E-Mail Address

(     )      -     

(     )      -     

     @     

3.       Main reason for the nomination (100-word summary)

     

 

RETURN THIS COVER SHEET WITH UP TO THREE ADDITIONAL PAGES OF DATA OR 1,500 WORDS (WHICHEVER IS GREATER) AMPLIFYING THE ACCOMPLISHMENTS OF THE INDIVIDUAL NOMINEE AND A COLOR PHOTO OF ANY SIZE TO:

DUSTOFF Association, ATTN: Hall of Fame, PO Box 8091, San Antonio, TX 78208 ON OR BEFORE JULY 1