REQUIRED:

1. Name of person submitting the nomination:

2. My phone number:

3. My email address:

4. Name of athlete being nominated:

5. Gender and age group of athlete:

6. To be nominated, athlete must meet at least one of the criteria below.
Please check at least one of the following:

(a) #1 ranked American masters athlete ____

(b) Set a new American Record _____ or World Record _____

(c) Gold medalist at the 2009 Masters National Indoor Championships _____

(d) Gold medalist at the 2009 Masters National Outdoor Championships _____

(e) Gold, silver or bronze medalist at 2009 WMA Championships ______

OPTIONAL:

1) Phone/email contact of the nominee:

2) Reasons for recommending this nominee: