Country Radio Hall of Fame Nomination Form

CRHoF Category

Name (If Nominating On Air Team, List Team Name)

First Name

Last Name

Next of Kin if Deceased

First Name

Last Name

Nominee (s) Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nominee Phone Number (Or, List On Air Team Contact Number)

(###)

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Nominee (or On Air Team Contact) Email Address

Submitted by:

Your Name

First Name

Last Name

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Phone Number

(###)

###

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Your Email Address

Name

First Name

Last Name