Athens Athletic Hall of Fame 
Nomination Form 
Player/Coach Name (In full):_____________________________________________________ 
Current Address: ______________City: State:_________________________Zip:__________ 
Home Phone:_______________Business Phone:_______________ Email:_______________ 
If Deceased, name of next of Kin:_____________ Address of next of Kin:________________ 
High School (s) Attended:_________________________Coach:________________________ 
College (s) Attended:_____________________________Circle one (Div I-A, I-AA, II, II, NAIA) 
Coach:________________________Years played (from-to):___________________________ 
College and/or Postgraduate Degree(s):___________________________________________ 
College Athletic Record (National/Conference):_____________________________________ 
Academic Honors:____________________________________________________________ 
Occupation(s):_______________________________________________________________ 
If a Coach, Record (W/L) & School Years:________________________________________ 
Current Occupation:__________________________________________________________ 
Civic Service:________________________________________________________________ 
Military:____________________________________________________________________ 
Married: Y/N Wife/Husband:____________________Children:______________________ 
Nominated by:______________________________Affiliation:________________________ 
College and/ of Postgraduate degree(s):_________________________________________ 
College Athletic record (National/Conference):____________________________________ 
Academic Honors:___________________________________________________________ 
__________________________________________________________________________ 
Occupation (s):_____________________________________________________________ 
If a Coach, Record (W/L) & School Years:_______________________________________ 
Current Occupation:_________________________________________________________ 

Civic Service:_______________________________________________________________ 
Military:___________________________________________________________________ 
Married: Y/N:________Wife:________________________Children:___________________ 
__________________________________________________________________________ 
Nominated by:_________________________________Affiliation:_____________________ 
Date:____/___/___ 
Mail all nomination material to: Mike Pilcher, 
Nomination Certification 
P.O. Box 527, Athens,GA 30603-527 
Email: Mike.pilcher@athenshealth.org