Nominee Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Birthday

MM

DD

YYYY

Was the nominee born in Alabama?

Yes

No

Does the nominee still live in Alabama?

Yes

No

Unsure

Type of Nomination

Individual Performer

Band

Songwriter

Non-Performer

Duet

Producer/Music Industry Executive

Other

Name

First Name

Last Name

Phone

(###)

###

####

By checking the box below, I acknowledge that my nomination does not secure an induction into the Alabama Music Hall of Fame. *

By checking the box below, I acknowledge that all the information above is correct to my knowledge. *

By checking the box below, I understand that I will be contacted if more information is needed. *