Inductee Information
Email
Secondary Email
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Email address *
First name *
Last name *
Address 1 *
Address 2
City *
State *
ZIP Code *
Cell Phone Number
Nickname:
Year you graduated from Bethany:
High School Information:
High School Attended and Year Graduated:
High School Academic & Athletic Achievements
College Information:
Athletic Participation (Sports/Years)
Athletic Honors (Captain, All Conference, Etc.)
Athletic Achievements (Leading Scorer, Records Set, Etc.)
Academic Achievements:
Social Organizations:
Other significant awards while at Bethany:
Family Information:
Souse's Name:
Bethany ties:
Children's Name & Ages:
Post College/Business Information:
What have you been doing since you have left Bethany:
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