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Fist Name___________________________ Initial______ Last Name____________________________ Nickname ( name tag use) ____________________________ Date of Birth __________________________Mailing Address (number and street)______________________________________________________ City________________________________ State_______ Zip Code +4___________________________ Home phone (_____) ______ - _________ E-mail Address ( optional) ____________________________Work Phone (_____) ______ - ________ Occupation ( optional) ________________________________AMA# ( mandatory)______________________________Academy of Model Aeronautics 5151 E. Memorial Dr. Muncie, IN 47302 Phone (800) 435-9262 Fax (765) 741-0057 E-mail You must show your 2000 AMA card or proof that you have joined AMA for 2000 in order to fly at or join the FIRST WEEDWACKER AERO SQUADRON, AMA CHARTER CLUB # 1651 CLUB FEES ARE Initiation Fee: $20.00 per family Additional Immediate Family Members: $18.00 Annual Dues: $36.00 Early Renewal ( by End of February Meeting) : $30.00First Year Prorated: $3.00 Monthly "I HAVE READ AND UNDERSTAND THE CACTUS PARK FIELD RULES FOR THE FIRST WEEDWACKER AERO SQUADRON AND THE ACADAMEY OF MODEL AERONAUTICS SAFETY CODE, AND I AGREE TO COMPLY WITH THESE RULES AND CODES." SIGNATURE: ______________________________________________________DATE: ____________ Complete this application and mail it to the club Treasurer or bring it to a regular monthly meeting. Meetings are held at the RENETTE RECREATION CENTER in El Cajon at 7:30 PM on the first Wednesday of each month (with the exception of the awards banquet in January). REV. 1/99
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