Internet app.
N.H.P.A./M.H.P.A Membership
Form 2012
Name _________________________________________________
Address
_________________________________________________
City______________________ Zip _____________________
Phone______________________ Date of Birth ______________
e-mail address _____________________________________________
New ____ Renewal
____ NHPA card # _________________
How many
years? _____________
Circle
category:
Men 40
feet Elders 30 feet Women 30 feet Juniors 30 feet
Adults: $17 for NHPA and $8 for MHPA, total $25
Juniors: $5
for NHPA and $5 for MHPA, total $10
Cathy Neumann
72 Six Rod Road
Fairfield, ME
04937
Phone:207-453-7443 e-mail: neumann8691@roadrunner.com
N.H.P.A./M.H.P.A Membership
Form 2012
Name _________________________________________________
Address
_________________________________________________
City______________________ Zip _____________________
Phone______________________ Date of Birth ______________
e-mail address _____________________________________________
New ____ Renewal
____ NHPA card # _________________
How many
years? _____________
Circle
category:
Men 40
feet Elders 30 feet Women 30 feet Juniors 30 feet
Adults: $17 for NHPA and $8 for MHPA, total $25
Juniors: $5
for NHPA and $5 for MHPA, total $10
Cathy Neumann
72 Six Rod Road
Fairfield,
ME 04937
Phone:207-453-7443
e-mail: neumann8691@roadrunner.com