YEAR: ________

National Horseshoe Pitchers Association (NHPA) and

Southern California Horseshoe Pitchers Association (SCHPA)

MEMBERSHIP APPLICATION FORM

IN ORDER TO KEEP ACCURATE RECORDS, WE MUST HAVE ACCURATE INFORMATION FROM THE MEMBERSHIP.

IF YOU HAVE A CHANGE OF ADDRESS OR PHONE NUMBER DURING THE YEAR, PLEASE NOTIFY THE SECRETARY/TREASURER OF YOUR NEW INFORMATION.

IF YOU HAVE A CHANGE IN PITCHING DISTANCE STATUS, PLEASE NOTIFY THE STATISTICIAN.

APPLICANT INFORMATION (please print clearly):

NAME:_________________________________________________________________

E-MAIL ADDRESS:______________________________________________________

ADDRESS:______________________________________________________________

CITY:__________________________STATE:_________ZIP CODE:______________

PHONE: (_____)___________________BIRTHDATE:__________________________

YOUR CLUB OR CHARTER:____________________________________

YEAR YOU BECAME AN NHPA MEMBER:______ OR NHPA MEMBER FOR _____ YEARS

LAST YEAR’S NHPA CARD #:_______________

DUES (circle one): ADULT @ $27.00 JUNIOR @ $6.00

SEX (circle one): M F PITCHING DISTANCE (circle one): 30ft 40ft

SIGNATURE OF APPLICANT: ______________________________________DATE:___________

MAKE CHECK PAYABLE TO: S.C.H.P.A.

MAIL THIS FORM AND CHECK TO THE SCHPA SECRETARY/TREASURER:

HAL GRISWOLD Phone: 949 / 496-0577 or Email: setibird@yahoo.com

32612 BALEARIC ROAD

DANA POINT, CA 92629

N.H.P.A./S.C.H.P.A. MEMBERSHIP RECEIPT

RECEIVED FROM: __________________________TOURN. DIR:______________________DATE:__________