Athletic Hall of Fame Induction Ceremony Registration

Please complete the form below and submit.

If you have any questions, please contact the Center for Alumni, Parents & Friends at 419-434-4516.

Name *

Address *

City *

State *

State1

Zip Code *

Telephone Number *

Email Address *

Please indicate if you are a current Hall of Fame Member *

Please indicate if you are a current Hall of Fame Member

Yes

Class Year if applicable

Number of adult guests attending $20

Number of children attending 6-12 $10

Number of children attending 5 & under free

Credit Card Information

Name as it appears on card

Credit Card number

Expiration date

3 digit security number

Amount

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