BERNE UNION AWARD OF MERIT
Nomination for Recognition

Criteria for Eligibility for Berne Union Athletic Hall of Fame:
A.  The Award of Merit will be presented to any individual(s) or business(es) who has contributed substantially to the athletic program at Berne Union High School, as determined by the Selection Committee.

Complete this form (please print legibly) and return it to:  Berne Union High School, Selection Committee, Athletic Hall of Fame, 506 N. Main Street, Sugar Grove, Ohio  43155.  The application must be received by the Selection Committee no later than March 1 for consideration for the next induction class.

Candidate’s Name ________________________________Phone (    )_______________
Address ________________________________________________________________
City _____________________________________State _________ Zip _____________

List below the candidate’s service to the athletic program at Berne Union.

Sport:_________________________________________Years:____________________
Service performed:________________________________________________________
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Sport:_________________________________________Years:____________________
Service performed:________________________________________________________
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Your Name: ___________________________________Phone (___)________________
Address: ________________________________________________________________
City, State & Zip: _________________________________________________________
Your signature: ___________________________________________________________

If Nominee is deceased, please name nearest relative or contact person below.          Name: ___________________________________Phone (___)_____________________
Address: ________________________________________________________________
City, State & Zip: _________________________________________________________

Comments:  Please explain why you think this candidate should receive the Berne Union Athletic Hall of Fame Award of Merit.  Please attach any additional materials you may think are necessary:
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