INTERNET APP

Vermont Horseshoe Pitchers Association-

Membership Application 2012

Name:________________________________________________________________

Address:______________________________________________________________

City:________________________________State:___________Zip:______________

Phone:______________________________Player Category:___________________

Date of Birth:________________________Pitching Distance:__________________

Years of Membership:_________________NHPA #:_________________________

Adult Dues…………….$ 21.00 $________

Senior Discount……….$ -3.00 _________

Junior Dues…………..$ 5.00 _________

NHPA Newsline Magazine

1 year subscription…..$ 12.00 _________

Amount Enclosed _________

Make checks payable to VTHPA

Mail application to: Donna Lewis

97 Trapp Rd.

Huntington VT 05462

For information or questions call: Donna Lewis

VTHPA Secretary

Phone: (802) 434-3155