ON THE WEB: www.newmexicohpa.com
Name: Telephone:
Address: Cell/Mess:
City: State: NM Zip:
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
8401 Spain Rd. NE, Apt 2H
Albuquerque, NM 87111
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: