FSHPA INC. MEMBER INFORMATION

NHPA DUES ARE $25.00 AND STATE DUES ARE $11.00

NAME: _________________________________________________ NHPA NUMBER ____________________

FLORIDA ADDRESS: __________________________________________________________ YEAR ________

CITY: _______________________________________ STATE: _____ ZIP CODE: ____________________

Go to http://www.fshpa.com to display and/or print Quarterly Newsletter

Newsletters are posted the first day of each quarter

March, June, September and December

FLORIDA PHONE NUMBER _______________________ EMAIL ADDRESS ________________________________________

OUT OF STATE ADDRESS: _____________________________________________________________________

CITY: _____________________________________________________ STATE: ______________ ZIP CODE: ____________________

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 PITCHING 30 FEET JUNIOR BOY PITCHING 30 FEET JUNIOR GIRL PITCHING 30 FEET

JUNIOR CADET

BIRTH DATE IF JUNIOR BOY, GIRL OR CADET ___________________________

Make checks payable to FSHPA INC

RETURN TO: MARCELA SANTOYO

10166 PINK CARNATION CT..

ORLANDO, FL 32825