Name:
Telephone:
Address:
Cell/Mess:
City:
State:
NM
Zip:
MALE ____ FEMALE
____
JUNIOR
____
ADULT
MEMBERSHIP
$35.00
$
JUNIOR MEMBERSHIP: AGE:
BIRTHDATE:
$ 10.00
$
TOTAL AMOUNT ENCLOSED: $
__________________________________________________________________________________________________________________________________
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: