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 (requested for all applicants) _______________________
Membership Categories
For those 19 or over as of July 1, 2001:
- □ Open Membership - $48.00 (Model Aviation included)
- □ Extra Family Membership - $30.00 (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 Programs:
- □ Museum Patron $25.00
- □ Supporting $100.00
- □ Sustaining $500.00
- □ Life $1,000.00
- □ FAI Stamp $35.00
- □ National Site Development $ ______
- □ Add $6.00 for Model Aviation mailed in an envelope
Payment: $ ______
- □ 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
- □ Aerobatic / Pattern
- □ Racing
- □ Indoor
- □ Electric
- □ Pylon
- □ Jets
- □ Combat
- □ Scale
- □ Outdoor
- □ Helicopter
- □ Soaring
- □ Speed
- □ Carrier
- □ Pattern
- □ Sport
Area of participation
(Check one)
(Area of participation options to be filled in by applicant)
Safety Code Compliance and Waiver and Release of Liability Statement
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.
"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 written notice must be provided within sixty days of the occurrence of any incident.
I am aware that modeling may present hazards to participants and spectators. I exempt, waive, and relieve the Academy of Model Aeronautics, Incorporated (AMA) from all current or future liability for personal injury, property damage, or wrongful death caused by negligence."
This waiver shall be in force at all times I am a member of AMA, and the waiver does not require me to re-sign 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.
