Tacoma-Pierce County Sports History Questionnaire

Please complete the following information regarding your involvement in sports as a player, coach, official, administrator, sportswriter/broadcaster, or any other capacity. This information will allow us to establish a comprehensive database from which a historical perspective for athletics can be maintained.

NOTE: Questions? Call or email Marc Blau at:
mhblau@comcast.net or 253-677-2872

Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Cell Phone
Cell Phone
- ### - ### ####
Email
Birth Date Birth Date / MM / DD YYYY
Birthplace
Current or Previous Occupation
Current or Previous Employer
EDUCATION
High School
High School City
Year Graduated
College
College City/State
Year Graduated
Sport (s) I participated in or was involved in (include position):
I participated for (teams/schools/league and years):
I coached for (teams/schools and years):
I officiated(leagues/conferences, years, sport):
I administered (leagues/conferences/schools/agency, title, years, sport):
Highlights of my athletic career (include records, averages, success of teams, all-star selections, amateur and professional status, playing honors, coaching, etc.):
Other sports I played (give stand-out records, honors, success of teams, etc.):
Please indicate names and addresses of teammates if you know where they are:
Please indicate memorabilia (photo, uniforms) you may have for display:
Any additional comments you wish to make:
Signature Date Signature Date / MM / DD YYYY
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Tacoma-Pierce County Sports History Questionnaire

Tacoma-Pierce County Sports History Questionnaire

EDUCATION