Name:                                                                                   Telephone:                                      

 Address:                                                                          Cell/Mess:                                        

PLEASE CHECK LINES THAT APPLY:

                    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: