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  ___________________________

 

RETURN TO:        MARCELA SANTOYO

                               10166 PINK CARNATION CT..

                               ORLANDO, FL 32825