Illinois Aviation Hall Of Fame

Download and Print Form

Honoree Candidate Data Form

PERSONAL INFORMATION:

Sponsor:

Name of Sponsor:

Address:

City:

State:

Zip:

Telephone:

Email:

Candidate:

Name of Candidate:

Address:

City:

State:

Zip:

Telephone:

Email:

HONOREE CANDIDATE DATA

1. Personal Information of Candidate:

Name:

Nick Name:

Date Of Birth:

Pilot Certificate:

Date:

Other Ratings:

Illinois Residency Dates:

Family Contact
(If deceased)
Name:

Relationship to Candidate:

Address:

City:

State:

Zip:

Telephone:

Email:

2. Statement as to how candidate's achievements have contributed to the advancement of aviation in Illinois. Please list on separate page.
3. Primary employment activities. Please list on separate page.
4. Aviation activities beyond employment ( volunteer efforts ). Please list on separate page.5. Recognition and Awards received ( Include copies ).
6. News articles of candidate ( include copies ).
7. Additional information or comments. Please list on separate page.
8. List two references familiar with the activities described.

Referrals:

Name:

Address:

City:

State:

Zip:

Telephone:

Name:

Address:

City:

State:

Zip:

Telephone:

9. Candidate Certification: By clicking submit, I hereby acknowledge I am willing to accept the nomination as candidate for the Illinois Aviation Hall of Fame. I certify this information is correct and may be used by the Illinois Aviation Selection Committee. All certification information will be verified.