NHPA Membership Application for the Year (_______)

(Fill out for one individual per form.)

State of Residence: (_________) (N)ew or (R)enewal Application

Name: (_________________________________________________)

Addr: (__________________________________________________)

City: (______________________) Postal Zip (_______________)

Phone: (_____-______-_________) Date of Birth (______________)

Circle only one pitching category that is applicable:                                         

(M)en (full dist.) - (W)omen (short dist.) - (E)lders (short dist.)

(B)oys (short dist.) - (G)irls (short dist.)

Have you ever held NHPA membership before and if so, how many

Years and in which State(s):________________________________

 Please send this form to the State Treasurer (For Ct Only) Plus Check for  $20.42  Payable to Bill Choser:

Send To: BILL CHOSER

                 356 WAKELEE Ave              

                ANSONIA CT  06401
               (203) 734-4640