Country Radio Broadcasters, Inc.

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DJ HALL OF FAME NOMINATION FORM
Criteria to be met:

Nominee must have worked on air 20 years in radio
Nominee must have worked a minimum of 15 years on air in country radio
Contribution to the growth and development of country radio
Contribution to the preservation and enhancement of country music as an art form

No limitation on recipient except that he or she cannot be a current member of the Board or Agenda Committee of Country Radio Broadcasters, Inc.

I hereby submit this applicant for nomination and entry into the Country Music Disc Jockey Hall of Fame and provide the following contact information:

Nominee Name
Next of Kin if Deceased
Nominee Address
City
State
Zip
Nominee Phone Number
Nominee Email Address

Submitted by:
Name
Address
City
State
Zip
Phone Number
Email Address