| NHPA/CT HPA Membership Application | ||||||||
| 2012 | ||||||||
| NHPA Membership Application for the Year ( 2012 ) | ||||||||
| (Fill out for one individual per form.) | ||||||||
| State of Residence: (_________) (N)ew or (R)enewal Application | ||||||||
| Name: (________________________________________________ ) | ||||||||
| Address: (__________________________________________________) | ||||||||
| City: (______________________) Postal Zip (_______________) | ||||||||
| Phone: (_____-______-_________) Date of Birth (___-______-_____) | ||||||||
| E-Mail Address (________________________________) | ||||||||
| Circle only one pitching category that is applicable: | ||||||||
| (M)en (full dist.) - (W)omen (short dist.) - (E)lders (short dist, men 70+) | ||||||||
| (B)oys (short dist.) - (G)irls (short dist.) Up to 18th birthday - (30) short distance (handicap) | ||||||||
| Have you ever held NHPA membership before and if so, how many years (____) | ||||||||
| Which State(s): (________________________________) | ||||||||
| League member ( Y ), ( N ) Which League (________________________) | ||||||||
| Please send this form to the State secretary (For Ct Only). | ||||||||
| Include Check $20.45* (adults) and $5.00 (juniors) | ||||||||
| Make checks payable to "CT HPA" | ||||||||
| * or $20.00 plus self-addressed envelope | ||||||||
| Send To: Debbie Scully | ||||||||
| 58 Maplewood Ave. | ||||||||
| East Hartford CT 06108 | ||||||||
| (860) 289-4655 | ||||||||
| Connecticut Horseshoe Pitchers Association | ||||||||
| President: Jim Halligan, Secretary: Debbie Scully | ||||||||
| Treasurer: Don Maine, Vice President: Susan Henson | ||||||||
| revised 10/21/2012 | ||||||||