Application Date:*

Your Name:*

Your Email:*

Your Phone:*

Nominee:*

Nominee Email:*

Nominee Phone:*

Nominee Street Address:

Nominee City, State, Zip:

Program:*
NSA Slow Pitch   NSA Fast Pitch   BPA Baseball

Category:*
Coach   Player   Umpire   Director
Park   Meritorious   Sponsor  

Years with NSA or BPA:*

Reason for Submitting:*