MEMBERSHIP APPLICATION and RENEWAL FORM

Please Print & Fill in Completely Renewals are due January 1^st & Delinquent February 15^th

AMA License No. ___________________

Name: ___________________________________________

Street: ___________________________________________

City: _____________________________ ZIP: _________

Telephone: (______) _______ - ________

Internet Address: ___________________________________

Skill Level: Student _____, 1-3 Years _____, 3-5 Years _____, 5 + Years ______

Radio Channels Used: _____, _____, _____, _____, _____, _____ Preferred Radio Brands: _________ _________

Are you available as an Instructor? Yes _____, No _____ If so, when? Weekdays ___, Saturday ___, Sunday ___

Interests: Sport _____, Scale _____, Helicopter _____

Will you participate in? Contests _____, Fun Flys _____, Pylon Racing _____, Combat _____, Barbecues ______

Annual Renewal – ($50 Membership + $20 Runway Fee) + ($10 Late Fee After Feb 15^th) $ ________

New Member Prorated Quarterly as Follows:

(Jan 1^st $50 April 1^st $37.50, July 1^st $25.00, Oct 1^st $12.50) + $50 One Time Runway Fee $________

Junior Member 18 Years Old and Under Dues Only $5 No Runway Fee, Must be accompanied by an adult. $ ________

TOTAL..........................................…........ $ ________

DATE: _______ Renewal: ____ New Member: ____ PAID BY: CASH______ or CHECK #________

Revised: 1/10/07

Mail this form, check, copy of current AMA card, & Self Addressed Stamped Envelope to:

Bengt Jonsson

735 Lotz Way

Suisun, CA 94585