Hall of Fame Nomination Form


This application must be submitted by a sponsor having a position of Zone VP, Zone or Regional UIC, Hall of Fame Committee Member, or NSA Board of Director.
Applications MUST be post marked no later than 10/1 of the current year and will not be processed without all required* fields completed

*Application Date:  
*Sponsor (Your) Name:  
*Email:  
*Phone:  
*Position with NSA/BPA:  
*Nominee:  
Nickname / Chosen Name:  
*Gender:  
*Email:  
*Phone:  
*Street Address:  
City, State, Zip:  
Marital Status:  
Spouse's Name:  
*Program:  
*Category:  
*Date Started with NSA or BPA:  
*Qualifying Statement:  
Three (3) Character Witnesses:
Applications must be submitted with a statement from each reference to jkimmel@playnsa.com within 48 hours.
Reference (1)*
Name:  
Phone:  
Street Address:  
City, State, Zip:  
Reference (2)*
Name:  
Phone:  
Street Address:  
City, State, Zip:  
Reference (3)*
Name:  
Phone:  
Street Address:  
City, State, Zip:  

         
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