Please provide the following contact information for yourself, the person making the nomination. The completion of information in all fields is necessary to assist in verifying the nominations. In areas where the information/field is marked required by an asterisk, (*), if the information is omitted the entire nomination may be discarded. If you do not have the information requested please state, in the appropriate field why not. For security purposes your email address is required. An invalid email address will constitute disqualification of the nomination. You will receive a confirmation of nomination receipt email. We may contact you for additional information regarding your nomination.

Name * (Required)

Your Email * (Required)

Organization

Website

Please state the name, city, and if known, contact point for your nomination.*

Please state an overall description for the reason of your nomination.*

Please list specific events, achievements, and or impacts which qualify your nomination for inclusion to the Q Hall Of Fame.*

Please list any URL's or printed information which substantiate your nomination.

Please list the names email and or snail mail contact points for three separate contacts who may verify your nomination claims. This is very helpful for localized nominations where large amounts of documentation are not available. (This is optional. However, if we cannot substantiate claims made in a nomination it is likely the candidate will not be accepted.)

Are you personally involved with your nomination? This will not disqualify the nominee. Only a lack of reason will disqualify. We ask this to better understand the environment of the nomination and those nominating.*

By submitting this nomination you attest that the information you have provided is true and accurate to the best of your ability and that you have knowingly made no false representations. Once submitted this form is not retractable, and becomes a document of record for the nomination and the nominee.