FSHPA INC. MEMBER INFORMATION

NHPA DUES ARE $17.00 AND STATE DUES ARE $11.00

 

NAME: _________________________________________________NHPA NUMBER ____________________

 

FLORIDA ADDRESS: __________________________________________________________YEAR ________

 

CITY:_______________________________________STATE: _____†††††† ZIP CODE: ____________________

 

SEND NEWSLETTER TO ABOVE ADDRESS FOR ISSUES (CIRCLE THOSE THAT APPLY)†††††††† MAR††††† JUN†††††††† SEP†††††††† DEC

DATE OF ISSUE IS FIRST DAY OF INDICATED MONTH.IF YOU WANT DELIVERY OF NEWSLETTER THROUGH FLORIDAíS WEB SITE CIRCLE HERE†††††††††††† WEBSITE DELIVERY††††††††††††††††††††††† IF CIRCLED NO HARD COPY WILL BE MAILED TO YOU.

 

FLORIDA PHONE NUMBER_____________________________________________

 

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

ABOVE LINE DOES NOT APPLY IF YOU CHOOSE TO RECEIVE THE NEWSLETTER THROUGH THE FLORIDA WEB SITE.

STATE OF LEGAL RESIDENCY ___________†††††††† NUMBER YEARS NHPA MEMBER_______________-

 

CIRCLE CATEGORY BELOW THAT APPLIES TO YOU

MALE PITCHING 40 FEET††††††††††† HANDICAPPED MALE PITCHING 30 FEET†††††††††††††††††† ELDER MALE PITCHING 30 FEET

 

WOMAN†††††††††††††††††††††††††††††††††††† JUNIOR BOY††††††††††† †††††††††††††††††††††††JUNIOR GIRL††††††††††††††††††††††† CADET(12 AND UNDER)

 

BIRTH DATE IF JUNIOR BOY ,GIRL OR CADET†††††††† ___________________________

 

SPONSORED BY:_________________________________________________

 

RETURN TO:††††††† MARCELA SANTOYO†††††† 10166 PINK CARNATION CT.††††††† ORLANDO, FL††† 32825

 

 

 

 

 

 

 

FSHPA INC. MEMBER INFORMATION

NHPA DUES ARE $17.00 AND STATE DUES ARE $11.00

 

NAME: _________________________________________________NHPA NUMBER ____________________

 

FLORIDA ADDRESS: __________________________________________________________YEAR ________

 

CITY:_______________________________________STATE: _____†††††† ZIP CODE: ____________________

 

SEND NEWSLETTER TO ABOVE ADDRESS FOR ISSUES (CIRCLE THOSE THAT APPLY) ††††††††MAR††††† JUN†††††††† SEP†††††††† DEC

DATE OF ISSUE IS FIRST DAY OF INDICATED MONTH..IF YOU WANT DELIVERY OF NEWSLETTER THROUGH FLORIDAíS WEB SITE CIRCLE HERE†††††††††††††††† WEBSITE DELIVERY††††††††††††††††††† ††IF CIRCLED NO HARD COPY WILL BE MAILED TO YOU.

 

FLORIDA PHONE NUMBER_____________________________________________

 

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

ABOVE LINE DOES NOT APPLY IF YOU CHOOSE TO RECEIVE THE NEWSLETTER THROUGH THE FLORIDA WEB SITE.

STATE OF LEGAL RESIDENCY ___________†††††††† NUMBER YEARS NHPA MEMBER_______________-

 

CIRCLE CATEGORY BELOW THAT APPLIES TO YOU

MALE PITCHING 40 FEET††††††††††† HANDICAPPED MALE PITCHING 30 FEET†††††††††††††††††† ELDER MALE PITCHING 30 FEET70+

 

WOMAN†††††††††††††††††††††††††††††††††††† JUNIOR BOY†††††††††††††††††††††††††††††††††† JUNIOR GIRL††††††††††††††††††††††† CADET(12 AND UNDER)

 

BIRTH DATE IF JUNIOR BOY,GIRL OR CADET††† ___________________________

 

SPONSORED BY:_________________________________________________

 

RETURN TO:††††††† MARCELA SANTOYO†††††† 10166 PINK CARNATION CT.††††††† ORLANDO, FL††† 32825