2009-10 HPTA Membership Application
July
1, 2009 - June 30, 2010
Check the following that apply:
_____ New Member _______
Renewing Member
_____ Single Membership ($15) _______
Family Membership ($20)
NOTE:
if paying between December 1, 2009 & June 1, 2010, membership dues are 1/2 annual dues amount.
Place an "X" in front of the contact information that you do NOT want published on the
HPTA website as a part of the membership roster
_____ Name: _________________________________________
_____ Address: _______________________________________
_____
City: ______________ State: _______ Zip ______
_____ Home Phone: __________________________________
_____ Cell Phone: ___________________________________
_____
Email Address: _________________________________
_____ NTRP Rating: ______________
_____ Senior Player (age 50 & Up) _____ Yes _____ No
If Family membership, list the participating members of your family
_____
Name: ______________________________ Email: ___________________________________
_____
Name: ______________________________ Email: ___________________________________
_____
Name: ______________________________ Email: ___________________________________
Payment Information: Make Checks Payable to "HPTA"
Mail Dues to following:
HPTA
c/o Heather Jayson
12221 Mollylea Drive
Baton Rouge, La 70815
Date Paid: ___________ Amount Paid: $________ Check #, if applicable _________
