Illinois Aviation Hall Of Fame

Honoree Candidate Data Form
Personal Information:
A.	Name of Candidate:
B.	Current Address:
	Address:
	City:
	State:
C.	Telephone:
D.	Date of Birth:
E.	Period of Illinois Residence:
	Date:
	Cities:
F.	Family Contact (if deceased):
	Telephone:
	Relationship:

Statement as to how candidate's achievements have contributed to the advancement of aviation in Illinois:
A.	Primary Employment Activities:
B.	Aviation Activities Beyond Employment:
C.	Recognition and Awards Received:
D.	Other Information or Comments:

List two references who are familiar with the activities described above:
	Name:
	Address:
	City:
	State:
	Zip:
	Phone:

	Name:
	Address:
	City:
	State:
	Zip:
	Phone: