OFFICIAL GSW HURRICANE HALL OF FAME

NOMINATION FORM

If you would like to nominate an individual for induction into the GSW Hurricane Athletic Hall of Fame, please complete the information below and forward to:

GSW Hurricane Hall of Fame Year Graduated ___________________________

ATTN: Debra D. Sloan

c/o Athletic Department Degree Received ___________________________

800 Wheatley Street

Americus, GA 31709 School Degree received from _________________

Name ________________________________________ Years Attended GSW __________

Address _____________________________________________________________________

Home Phone ______________________________ Work Phone _______________________

Sport(s) _____________________________________________________________________

Honors Received _____________________________________________________________

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Major Accomplishments (while at GSW and since leaving) ____________________________

____________________________________________________________________________

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*attach a separate sheet if necessary or attach newspaper clippings, etc.

Additional Comments __________________________________________________________

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Name of person filling in nomination form _________________________________________

Address _____________________________________________________________________

Home Phone ___________________________________ Work Phone _________________

RETURN BY JUNE 13