Michigan Irish American Hall of Fame Nomination Form
Nominee
Nominee's First Name
Middle
Nominee's Middle Name
Last Name
Nominee's Last Name
Date of Birth (MM/DD/YYYY)
Nominee's Date of Birth
Nominee is
Clear selection
Nominee is
Clear selection
(Mr., Mrs., Ms., etc)
Nominee's Title
Deceased Date (if applicable)
Contact Name
Contact information for Nominee or, if deceased, suggested representative of Nominee
Relationship
Relationship to Nominee
Contact Phone
Contact Email
Contact Address
City
State
Zip
Area of Contribution:
Nominee must have made a notable contribution in one of the listed areas.
Clear selection
Basis for Nomination
Please summarize the notable contributions and achievements of the nominee; the nominee's connection to Michigan; and the nominee's Irish Heritage.
Nomination Submitted by
Address
City
State
Zip
Phone
Email
Submit
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