IOWA SENIOR OLYMPICS HALL OF FAME AWARD

NOMINATION FORM

Name of person being nominated _______________________________________________________________

Reasons why this person is being nominated _______________________________________________________

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Signature of person making the nomination _______________________________________________________

Date of nomination _____________________

To be completed by Iowa Senior Olympics:

Number of years of participation _________ Record holder ________________

Number of gold medals won ____________ Athlete or Rookie of Year ______

Number of total medals won ____________ Contributor __________________