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Florida Half Century Amateur Softball Association
Replacement / Updated Card
01/02/2025
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Replacement /
Updated Card
| First Name | Middle Name | Last Name |
| Permanent Home Address |
| City | County | State | Zip |
| Telephone Number | Date of Birth | / | / |
Part Time Florida Residents complete this section
| Months residing in Florida: From | to |
| Street Address in FL |
| City | County | Zip |
| Telephone number, if different from above |
| Current FHC number | If not known, approximate year you got your card |
Reason for needing a new Card:
| Lost original, same address above |
| Moved to a new Area - new address is above |
| old address |
| Requesting to be Grandfathered to old area. Explanation for why you want to be grandfathered: |
| I have not been on roster for any teams in new area |
| I would like to be grandfathered in so I can continue to play with my current team: |
Grandfathering Requests must go
through the Chairman, Mike Correa. Call 321-501-4141 to explain your situation. If approved, he
will write the date here ______________________________
Mail:
| 1. | Completed form |
| 2. | $25 replacement fee - Personal or Business Check / Money Order / Cashier's Check Payable to Florida Half Century ASA, Inc. |
| 3. | Copy of current Driver's License or proof of current residence. |
| Date | Signature of Applicant |
|
Type or Print Legibly, mail this application, proof of address and fee to:
Mike Correa
177 Tahiti Circle
Naples, FL 34113
321-501-4141
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Type or print clearly, mail this application, proof of address and fee to:
Mike Correa
177 Tahiti Circle
Naples, Florida 34113
Naples, Florida 34113
Call 321-501-4141, if any questions
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