AMA Membership Application
Academy of Model Aeronautics 5151 E. Memorial Dr. Muncie, IN 47302 1-800-435-9262
Only one applicant per form. You may photocopy if needed.
- [ ] New member
- [ ] Renewal: give old number if known _______________________
First Name ___________________ Initial _____ Last Name ________________________
Mailing Address (number and street) _____________________________________________
City _______________________________ State ________ Zip Code ________________
You may send this application by fax if paying by VISA or MasterCard. Fax Number: 1-765-741-0057
- [ ] Yes, please send a confirmation to: Fax number: (___) ___ - ____ - _____
Home phone number: (___) ___ - ____ - ________ E-mail Address ___________________________
Work phone number: (___) ___ - ____ - ________
All membership categories receive full membership and competition privileges, liability and accident/medical insurance.
Date of Birth (required for all applicants) ____________________
Membership Categories (as of July 1, 2001)
For those 19 or over as of July 1, 2001
- [ ] Open Membership - $48.00 — Model Aviation included.
- [ ] Extra Family Membership - $30.00 — This category applies to any one adult who currently resides at the same address as a current Open Member; magazine not included.
Current Open member's name and AMA number ____________________________________
For those 65 or over as of July 1, 2001
- [ ] Senior Citizen Membership - $38.00 — (Must submit proof of age at time of original application). Model Aviation included.
Options
- [ ] Museum Patron $25.00
- [ ] Supporting $100.00
- [ ] Sustaining $500.00
- [ ] Life $1,000.00
- [ ] FAA Stamp $35.00
- [ ] National Site Development $_________
- [ ] Add $6.00 for Model Aviation mailed in an envelope
Amount enclosed: $_________
- [ ] Check
- [ ] VISA
- [ ] MasterCard
Credit Card No. ____________________________ Exp. Date _____ / _____
Card Holder's Signature ______________________________________
NEW REDUCED PRICE
For those under 19 as of July 1, 2001
- [ ] Youth Membership - $13.00 — Model Aviation included.
- [ ] Youth Membership - $1.00 — magazine not included.
FOR HQ USE ONLY
Primary Interests: (check one)
- [ ] Control Line
- [ ] Free Flight
- [ ] Radio Control
- [ ] Rocketry
Area of participation: (check one)
- [ ] Aerobatic
- [ ] Racing
- [ ] Combat
- [ ] Scale
- [ ] Indoor
- [ ] Outdoor
- [ ] Electric
- [ ] Pylon
- [ ] Jets
- [ ] Helicopter
- [ ] Soaring
- [ ] Speed
- [ ] Sport
- [ ] Carrier
- [ ] Scale
- [ ] Other _________________
Waiver, Release of Liability, and Safety Code Compliance
Everyone MUST read and sign below - applications without signatures will be returned.
Note: this waiver means that if I am involved in any claim or suit I will not sue the AMA, Inc. I understand that this waiver does not affect my liability insurance coverage.
Safety Code compliance and waiver and release of liability statement:
"I agree to comply with the AMA Safety Code for all applicable model operations. I understand that my failure to comply with the Safety Code will result in failure of liability coverage for any damages or claims so caused. I further understand that AMA membership may be revoked if I fail to comply with any AMA rule or regulation, and that the Academy may present hazards to participants and spectators. I hereby release, waive, and forever discharge the Academy of Model Aeronautics, Incorporated (AMA) from all claims of liability for personal injury, property damage, or wrongful death caused by any negligent act, omission, or failure to act by any member and/or by the AMA."
This waiver shall be in force at all times I am a member of AMA, and the waiver does not require my re-signature when I renew my membership.
Signature of applicant ___________________________ Date ____________
Parent or Guardian of applicant under age 18 must also sign form ______________________
Transcribed from original scans by AI. Minor OCR errors may remain.
