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