Palos R/C Flying Club  Membership Application

 

	Regular Member: Must show current AMA card
	Associate Member: Non-AMA member - CAN NOT FLY

(Associate membership is convertible to Regular membership upon presentation of a valid AMA card.)  --- Please Print --- 

Date:	______________________
Name:	__________________________________________________________
Address:	__________________________________________________________
	City:__________________	State:_______	Zip:_______________
	Phone:(_______)_______-___________
	Birth date:	_______/_______/_______
Occupation:	__________________________________________________________
AMA Number:	________________________
E-Mail Address:	________________________
Radio Frequencies:	_______/_______/_______/_______

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Membership Fees

Open Membership (Age 19 or older)	$40.00	$____________
Senior Membership (Age 62 or older)	$25.00	$____________
Junior Membership (Younger than 19)	$10.00	$____________
Family Plan (children less than 19)	$55.00	$____________
Initiation Fee (each member, includes Cap & Pin)		$25.00
Total Fees:		$____________
Note: New application paid after 9/1 apply for the balance of the year and the next full year.