Required fields are marked in italics.
Your Name:
Your E-mail:
Your Phone Number: Home Work
Your Class Year or Other Haverford Affiliation:
Your Street Address:
City: State: Zip Code:
First Name:
Middle/Maiden Name:
Last Name:
Class Year:
E-mail:
Daytime Phone: Home Work Cell
Evening Phone: Home Work Cell
Street Address:
Deceased: Yes No
Sport(s) Played at Haverford:
Please explain how the nominee demonstrated significant success/achievement in their sport(s). Include any records, award, statistics, etc.
Please provide any additional comments below.