Stoneleigh-Burnham School -> Riding -> Wall of Fame -> Equestrian Wall of Fame Nomination Form

Wall of Fame Nomination Form

You may submit an online nomination for the Stoneleigh-Burnham School Equestrian Wall of Fame. Nominations received will be considered for the induction Class of 2012. Please scroll to the bottom of the page for the nomination form.

Deadline for nominations for the Inductee Class of 2012 is June 30, 2012.

Nominee Information

First Name*

Last Name*

Address 1

Address 2

City

State

ZIP

Phone

Fax

Email*

Current Position/Status*

Please explain Nominee's current/past position in the equine field

Equine Achievements/Positions of Leadership/Honors*

Past Employment

Community Service in Equine field

Additional Information

Nominator Information

Nomination Submitted by*

Date Submitted*

Address*

Phone number*

Email address*

Additional references for Nominee

Electronic Signature*