FSHPA INC. MEMBER INFORMATION
NHPA DUES ARE $17.00 AND STATE DUES ARE $10.00
NAME:
_________________________________________________ NHPA NUMBER ____________________
CITY:
SEND
NEWSLETTER TO ABOVE ADDRESS FOR ISSUES (CIRCLE THOSE THAT APPLY) MAR JUN SEP DEC
DATE
OF ISSUE IS FIRST DAY OF INDICATED MONTH
CIRCLE FOR WEB SITE DELIVERY
See
back of this form
OUT
OF STATE ADDRESS:
_____________________________________________________________________
CITY:
_____________________________________________________ STATE:
______________ ZIP CODE: ____________________
SEND
NEWSLETTER TO OUT OF STATE ADDRESS FOR ISSUES (CIRCLE THOSE THAT APPLY) MAR JUN
SEP DEC
STATE
OF
CIRCLE CATEGORY BELOW THAT
APPLIES TO YOU
MALE
PITCHING 40 FEET HANDICAPPED
MALE PITCHING 30 FEET
ELDER MALE PITCHING 30 FEET
WOMAN
PITCHING 30 FEET JUNIOR BOY
PITCHING 30 FEET JUNIOR GIRL
PITCHING 30 FEET
BIRTH
DATE IF JUNIOR BOY OR GIRL
___________________________
RETURN
TO: MARCELA SANTOYO