IHHPA Membership Form
Name_________________________________________ Male (__) Female (__)
Address____________________________________________
City______________________________, IA ZIP__________
Phone (_____)______-_________ Date of Birth (M/D/Y) ____-____-_______
eMail Address _____________________________________
Recieve newsletter via email - please circle Yes No
Check one: (__) Membership Renewal (__) New Member
Pitching Distance: (__) 30 Feet (__) 40 Feet
(__) Jr. (18 & Under) (__) Jr. Cadet (12 & Under)
NHPA/IHHPA Dues and Newsletter ($31) ....................................$______
Second Adult in household, 1 maximum ($20)...........................$______
Additional Member's Name: __________________________
Junior Dues ($7 per child) .............................................................. $______
National Newsline Subscription (1 Year-$12 OR 3 Years-$30) ...$______
TOTAL ENCLOSED (make checks payable to IHHPA) ...............$______
Mail to: Ron Rowley, IHHPA Sec./Treas.
201 36th St.
West Des Moines, IA 50265
(515) 223-5779