N.Y.S. OUTDOORSMEN HALL OF FAME ASSOCIATION

P.O. Box 605,  Poland, NY  13431

N.Y.S. OUTDOORSMEN HALL OF FAME ASSOCIATION

P.O. Box 605

Poland, NY 13431

Nomination Form

(Please Print)

1. Name of Nominee____________________________________   Date____________

2. Address______________________________  City________________  Zip_______

3. County_________________  Phone__________________  E-mail_______________

4. Name of Nominating Organization_________________________________________

5. Name of Nominating Person _______________________________________

    Address______________________________ City_______________Zip__________

    Phone________________   E-mail________________________________

6. Category Nominated For:  ___ Outdoorsperson – Volunteer         

____Media Professional     ____Outdoor Professional

 *Since the emphasis or consideration will be given to items number 7 and 8 below, please attach separate sheets listing and explaining the information asked for.

7. List Specific Achievements for Conservation and Youth Education:

8. List achievements or contributions that the Nominee has given back for future generations or preserving our outdoor heritage and outdoor sports:

   ** Please attach any documentation, including reference letters that you feel necessary and pertinent to the nomination.

Check the web site www.nysohof.org for information or contact numbers.

(