AMA Membership Application
ACADEMY OF MODEL AERONAUTICS
Application for 2003 Membership - One Individual Per Application
Please print or type the information clearly. If E-Mail address is provided, the AMA may periodically send you E-Mail notices. AMA, 5151 E. Memorial Dr., Muncie, IN 47302-9252; www.modelaircraft.org
First Name ______________________ Initial _____ Last Name ______________________
Mailing Address (number and street) ____________________________________________
City _________________________ State _____ Zip Code ________
Home tel.: (_____) ____________________ Work tel.: (_____) ____________________ FAX: (_____) _______________
E-mail: ___________________________ □ New □ Renewal (give old number if known)
□ Yes, I was recruited by an AMA member. Member’s name ______________________ AMA # ______
If you supply us with your E-mail address, you may receive periodic messages with information on important legitimate activities, your membership status and benefits, or upcoming events. AMA does not trade or sell E-mail addresses. If at any time you do not want to receive E-mails from AMA, please let us know by e-mailing us at [email protected]
MEMBERSHIP CATEGORIES: All membership categories receive full membership rights and competition privileges, and liability and accident/medical insurance.
For those 19 or over as of July 1, 2003
□ OPEN Membership $55.00 (Model Aviation included. (18 & 19a required.) Those 65 or over by July 1, 2003 may elect a $40.00 reduced dues rate. (Proof of age at time of original application.)
□ EXTRA Family Membership $30.00 (Requires an OPEN member at same address. If this is your first time as a current OPEN member, magazine not included. List current OPEN member’s name and AMA number.)
For those under 19 as of July 1, 2003
□ YOUTH Membership $15.00 (Model Aviation included) (date of birth required)
□ YOUTH MAGAZINE (magazine not included) $11.00 (date of birth required)
For Non-US and North American Permanent Residents
□ AFFILIATE MEMBERSHIP $28.00 (insurance only while flying in the USA, magazine not included). Name of National/Local CLUB ___________________________ Expiration date ___________
□ AFFILIATE MAGAZINE SUBSCRIPTION to non-U.S. address - add $20.00 for a total of $48.00.
For Canadian Residents AMA has a reciprocal agreement with MAAC. A current MAAC card will be honored at all times and will be coded as an affiliate. If you would like AMA to be your primary membership in addition to MAAC, choose the proper membership rate and enclose $24.00 postage and handling to forward magazine to the outside of the United States.
OPTIONS: □ Business Patron Program □ Life with Patron $2,500 □ Supporter $1,000 □ Sustaining $500 □ Life $1,000,000 □ FAi Stamp $50.00 □ Donate □ Add $5.00 TO COVER FEE (button mailed in envelope)
Please print this: (check one) Area of Participation: (check one) □ Control Line □ Aerobatic □ Carrier □ Combat □ Racing □ Free Flight □ Indoor □ Outdoor □ Scale □ Sport □ Radio Control □ Electrics □ Helicopter □ Pattern □ Sport □ Scale □ Soaring □ Jets □ Rockets
PAYMENT OPTIONS: Check enclosed $ _______ Charge my: □ Visa □ MasterCard $ _______
Card No. _________________________ Exp. date ______ Cardholder’s signature ____________________
Please read and sign the declaration. Applications without signature will be returned.
I agree to comply with the AMA Safety Code for all applicable model operations. I understand that my ability to comply with the Safety Code will result in the privilege of flying model aircraft. I hereby release and hold harmless the Academy of Model Aeronautics, its officers, agents, and employees, from all claims, damages, or liability arising out of or resulting from participation in Academy activities, except those arising from gross negligence or willful misconduct. I accept responsibility for all damages or injuries caused by my model(s) or my operations.
Signature __________________________ Date ______________ Parent or Guardian signature if under 18 _______________________
ONLY ONE APPLICANT PER FORM
Transcribed from original scans by AI. Minor OCR errors may remain.
