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MEMBERSHIP APPLICATION - 2012
NAME
__________________________________________________
AMA #
________________________________
ADDRESS
______________________________________________
DATE OF BIRTH
_______/_______/________
CITY
___________________________________________________
PHONE (______)
_______________________
STATE __________________________
ZIP ___________________
YEARS IN R/C
_________________________
E - MAIL
ADDRESS________________________________________________________
CAN WE PUBLISH YOUR PHONE NUMBER IN OUR
DIRECTORY? YES
______________ NO
______________
R/C CHANNEL NUMBERS UTILIZED AT THIS
TIME
________________________________________________________
MAJOR R/C INTERESTS - PLEASE CHECK ONE OR
MORE
SPORT _____ SCALE
_____ PATTERN _____
RACING _____ COMBAT
_____ OTHER
__________________
IF RETURNING
THIS APPLICATION BY MAIL, INCLUDE A
PHOTOCOPY OF YOUR
AMA CARD AND ENCLOSE
A LARGE, SELF-ADDRESSED, STAMPED ENVELOPE
MEMBERSHIP DUES
_____ $50.00 ( $25.00 AFTER SEPTEMBER 1ST FOR NEW MEMBERS )
RUNWAY ASSESSMENT
_____ $20.00 ( NEW MEMBERS - ONE TIME ONLY )
INITIATION FEE
_____ $15.00 ( NEW MEMBERS AND RENEWALS AFTER ONE YEAR LAPSE )
LATE FEE
_____ $5.00 ( LATE FEE FOR RENEWALS AFTER JANUARY 31ST )
JUNIOR MEMBER DUES
_____ $20.00 ( UNDER 19 AND PARENT NOT AN ACRC MEMBER )
FAMILY MEMBER DUES
_____ $5.00 ( MEMBER'S CHILD UNDER 19 YEARS OLD OR SPOUSE, IF FLYING )
TOTAL PAID
$
(MAKE CHECK OUT TO ACRC)
AMA ____________
I HEREBY CERTIFY THAT I WILL BECOME
FAMILIAR WITH THE RULES AND SAFETY
PROCEDURES OF
ANOKA COUNTY RADIO CONTROL, INC. AND THE
ACADEMY OF MODEL AERONAUTICS, ESPECIALLY
THE AMA SAFETY CODE.
I WILL FOLLOW AND ENFORCE SAID
RULES AND SAFETY PROCEDURES, AND
UNDERSTAND THAT
MY FAILURE TO DO SO MAY RESULT IN THE
TERMINATION OF MY MEMBERSHIP IN
ANOKA COUNTY RADIO CONTROL, INC.
I ALSO CERTIFY THAT I HAVE READ AND
UNDERSTAND THE RULES OF ANOKA COUNTY RADIO
CONTROL, INC.
SIGNED
__________________________________________________________
DATE ____________________________
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