Test Form

CANDIDATE NAME:

Is your candidate still alive? YesNo

[group alive]Address: City: State: Zip:

CANDIDATE TELEPHONE

CANDIDATE EMAIL
[/group]

CANDIDATE HISTORY
What category or categories does your candidate fall under? (You may select more than one)
Accomplishments / ContributionsDevelopmentEd Yost Master Pilot AwardHall of FameMontgolfier Ballooning DiplomaPast PresidentsRecordsShields Trauger AwardUnited States Hall of Fame MemberUnited States or World Record HoldersOther

[group other]Please give us a little more information on why you chose Other.
[/group]

Tell us about your Balloonist. Please give as much history as you can. You will be able to attach files below. (You may copy and paste in this box or attach files below.)

Include a picture of the balloonist, other appropriate ballooning pictures and other files that contribute to the biography. You may attach the following file types. (gif, jpg, jpeg, tif, png, doc, docx, pdf, xlsx.) Please keep files under 2MB

PERSON MAKING THE SUBMISSION

Submitter Name (required)

Submitter Address: City: State: Zip:
Submitter Email (required)
Submitter Phone:

Provide References: Identify two individuals that can speak to the quality and significance of the achievement, and to the character of the candidate.

REFERENCE #1 NAME
TELEPHONE OR EMAIL

Phone

Email

REFERENCE #2 NAME
TELEPHONE OR EMAIL

Phone

Email