NEW YORK STATE
HORSESHOE PITCHING HALL OF FAME RECOMMENDATIONS

NAME OF PROPOSED CANDIDATE_________________________________________________
ADDRESS OF CANDIDATE OR REPRESENTATIVE___________________________________
STREET__________________________________________________________________________
CITY OR TOWN___________________________ZIP_____________________________________
TELEPHONE________________________________
BORN____________________DIED________________________AGE______________________
MARITAL STATUS_______________ SPOUSE'S NAME________________________________
CHILDREN:
NAME:________________________________________AGE_____________________________
NAME:________________________________________AGE_____________________________
NAME:________________________________________AGE_____________________________
NAME:________________________________________AGE_____________________________
NAME, ADDRESS, TELEPHONE OF CLOSEST RELATIVE:
_____________________________________________________________________________
Requirements:

1. Print or type on separate sheet called write-up sheet. 2. Indicate in upper right corner of write-up sheet whether
candidate belongs in Promoter OR Pitcher category. 3. Write-up sheet to include the personal interests and
accomplishments of the applicant. 4. Applicant must have been a member of NYSHPA for at least FIVE consecutive
years. 5. Three (3) additional signatures must be submitted when making request. These people must have been or do
belong to the New York State Horseshoe Pitchers Association.

 SIGNATURE VERIFICATION:  1.____________________________  PRINT NAME  ________________________________
 SIGNATURE VERIFICATION:  2.____________________________  PRINT NAME  ________________________________
 SIGNATURE VERIFICATION:  3.____________________________  PRINT NAME  ________________________________
 PROPOSED BY
ADDRESS
TELEPHONE		  _____________________________
______________________________
______________________________		  PRINT NAME  ________________________________


Forward this form by December 31st to:
Rose Wright (Chairman of the Hall of Fame)
1 Englebride Pl
Newburgh, NY 125501