Inductee Information

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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 Attended and Year Graduated:

High School Academic & Athletic Achievements

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:

Souse's Name:

Bethany ties:

Children's Name & Ages:

What have you been doing since you have left Bethany:

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