2018 MEMBERSHIP APPLICATION   
                                                          ON THE WEB: www.newmexicohpa.com

 Name:                                                                                   Telephone:                                      

 Address:                                                                          Cell/Mess:                                        

 City:                                                                                State:   NM   Zip:                                   

PLEASE CHECK LINES THAT APPLY:

                    MALE    ____       FEMALE   ____        JUNIOR    ____

Pitching Distance:   40 Ft._____ ;Less Than 40 Ft._____;ELDER_____ ;JUNIOR CADET_____

                             MEN_____  WOMEN & JUNIORS_____

                                                                                                                          FEES                AMOUNT

                       ADULT MEMBERSHIP                                                                $35.00             $                               

 JUNIOR MEMBERSHIP:      AGE:             BIRTHDATE:                                  $  10.00             $                               
                               

 

                                                                         TOTAL AMOUNT ENCLOSED:                          $                               

__________________________________________________________________________________________________________________________________

 MAKE CHECK OR MONEY ORDER PAYABLE TO:   Pearl Platero   
                                                                   
                                                         
Mail to :           Pearl Platero
                                                                                    8127 Camino Del Venado NW
                                                                                    Albuquerque, NM 87120

                                                                                    (505) 862-4285
                                                                                    rez_squirel@yahoo.com

 PARTICIPANTS LIABILITY RELEASE:   In consideration of participating in such activity, I hereby waive, release and forever discharge the New Mexico Horseshoe Pitchers Association, all officers, employees, agents and servants of the afore stated organization, and all fellow participants of this event, for any and all action, cause of action, damage, loss or injury, which I may suffer as a consequence of participating in the New Mexico Horseshoe Pitchers Association Sanctioned NHPA tournaments.

SIGNATURE:                                                                  DATE:                           

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