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UNITED STATES MARTIAL ARTIST ASSOCIATION

2008 Hall of Fame Awards Ceremony

Inductee Response Form

All areas below are required to be completed before your nomination is processed.

All spelling must be correct. This will be how your awards will be engraved/written.

(Members of the United States Martial Artist Association are not responsible for incorrect spelling)

Nominator's Information

       First Name                                M.I.                                   Last Name          

Street Address                                                    City                                                   State/Country       Zip

        Telephone                                                                      E-mail Address (if available)

Required Information

Select Choice Black Brown Red Green Blue Gold Yellow Purple White Select Choice 10 9 8 7 6 5 4 3 2 1 Select Choice Degree Kyu/Gup

Belt                                Rank                             Class

Required Information

Style or Discipline of Martial Art

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Nominee's Information

Membership Status

Select Member Non-Member

Membership Number

       First Name                                M.I.                                Last Name          

      Street Address                                                             City                                      State/Country    Zip

        Telephone                                                                      E-mail Address (if available)

Required Information

  Select Choice Black Brown Red Green Blue Gold Yellow Purple White Select Choice 10 9 8 7 6 5 4 3 2 1 Select Choice Degree Kyu/Gup

Belt                                Rank                             Class

Approximate Age of Nominee

Required Information

Style or Discipline of Martial Art

Ballot Category Selection Required

Select Choice In Memory Of Platinum Life Achievement (Over 40 Years of Martial Arts Practice) Golden Life Achievement (31-40 years practice) Silver Life Achievement 20-30 years practice) Bronze Life Achievement (15-19 years of pracice) Supreme Grandmaster of the Year (9th & 10th Degree) Minimum Age 50 Years Old Grandmaster of the Year (8th Degree) Minimum Age 50 Years Old Supreme Master of the Year (7th Degree) Master of the Year (5th and 6th Degree) Apprentice Master of the Year (4th Degree) Instructor of the Year Associate Instructor of the Year Student of the Year Man/Woman of the Year All-Around Competitor of the Year Forms Competitor of the Year Forms Practitioner of the Year Weapons Competitor of the Year Weapons Practitioner of the Year Sparring Competitor of the Year Sparring Practitioner of the Year Self-Defense Competitor of the Year Self-Defense Practitioner of the Year One-step Competitor of the Year One-Step Practitioner of the Year Breaking competitor of the Year Breaking Practitioner of the Year Most Dedicated Martial Artist of the Year Outstanding Martial Artist of the Year Outstanding Contribution to the Martial Arts Special Contribution to the Martial Arts Parent of the Year (Martial Artist) Parent of the Year (Non-Martial Artist) Humanitarian of the Year Special Martial Arts Appreciation Special Individual Achievement Inspiration of the Year Public Servant of the Year - Law Enforcement Public Servant of the Year - Fire Fighter School of the Year

Write a brief biography of your Martial Arts History