Nomination Ballot

Your Information

*First Name:

*Last Name:

Art or Organization:

Title/Rank:

E-mail Address:

Telephone:

Address/Line 1:

Address/Line 2:

City:

State/Territory/Province:

Zip/Postal Code:

Country:

Nominee Information

*First Name:

*Last Name:

Art or Organization:

Title/Rank:

E-mail Address:

Web site:

Telephone:

FAX:

Address/Line 1:

Address/Line 2:

City:

State/Territory/ Province:

Zip/Postal Code:

Country:

Areas of Expertise:
(check one or more)

Traditional Martial Arts
Non-classical Martial Arts
Weapons
Competition and Tournaments
Self-defense
Outstanding Accomplishments
Other (please specify)

Specific Nomination Title:
(ie. Master of the Year – Kung Fu)

*Briefly tell us why you consider this person a qualified candidate for induction in the Universal Martial Arts Hall of Fame

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