AMA Membership Enrollment Form
ACADEMY OF MODEL AERONAUTICS Enrollment form for 2013 Membership - ONLY ONE FORM PER INDIVIDUAL 5161 E. Memorial Dr., Muncie, Indiana 47302-9050, Fax: (765) 741-0057, www.modelaircraft.org
[ ] Mr. [ ] Mrs. [ ] Ms. [ ] New Membership [ ] Renewing Member (provide AMA number if known)
First Name ___________________ Initial ____ Last Name _________________________________
Mailing Address (number and street) _________________________________________________ Apt. # _______
City ___________________________ State ________ Zip Code _________
Home tel. (____) _________ Work tel. (____) _________ FAX (____) _________
E-mail _______________________________________ Date of Birth (Required) _______________
The AMA has provided AMA with the opportunity to get information to our members in a timely cost-effective manner. AMA on occasion partners with reputable firms to promote products that will benefit both the member and the association. AMA does not trade or sell e-mail or mailing addresses. [ ] Do not use my e-mail address for anything other than official AMA business [ ] Do not use my mailing address for anything other than official AMA business.
MEMBERSHIP CATEGORIES * All membership categories receive full membership, liability and accident/medical insurance, and competitive privileges
OPEN Adult Memberships - For those 19 or over as of July 1, 2013 [ ] OPEN Membership $58.00 Model Aviation included.
NEW OPEN Members - New AMA members joining during these periods will receive a prorated membership price. [ ] April 1st through June 30th $43.50 [ ] July 1st through September 14th $29.00
[ ] OPEN Senior Membership $48.00 Model Aviation included. (For those 65 or over by July 1, 2013).
NEW OPEN Senior Members - New AMA members joining during these periods will receive a prorated membership price. [ ] April 1st through June 30th $36.00 [ ] July 1st through September 14th $24.00
[ ] EXTRA Family Membership $30.00 Model Aviation not included. (Applies to any one adult who resides in the same household as a current OPEN member.) List current OPEN member’s name and AMA number. Name ________________________ AMA# ____________
[ ] PARK PILOT PROGRAM* $29.95 Park Pilot magazine included. *Aircraft must not exceed 2 pounds, 60 mph, and may not be powered with an internal combustion engine. * Does not have voting rights, cannot compete in competitions, and has reduced liability insurance and no fire, theft, or accident/medical insurance. Park Pilot members can subscribe to Model Aviation magazine - $36.00
Free Youth Memberships - For those under 19 as of July 1, 2013 Note: For competition purposes, YOUTH will be categorized as Junior (under 15 by July 1) or Senior (Those 15 by July 1 but not 19) [ ] FREE YOUTH Membership [ ] Add Model Aviation magazine subscription. One-year $15.00 [ ] Add Park Pilot magazine subscription. One-year $9.95
For Non-U.S. Permanent Residents [ ] AFFILIATE MEMBERSHIP $28.00 insurance only while flying in the USA. Model Aviation not included. Membership in National Aero Club (NAC) is required. Please provide copy of NAC membership card/record. Name of National Aero Club __________________________ Expiration Date _______________ [ ] AFFILIATE MAGAZINE SUBSCRIPTION add $60.00 for a total of $88.00.
Recruiter Information: If you were recruited to join AMA by a member, AMA Club, or hobby shop, please indicate only one and list the name and AMA number (if known) so we can thank them. [ ] Member/Club/Hobby Shop - Name __________________________ AMA# ___________
Support AMA Programs Scholarship Fund [ ] $25 [ ] $50 [ ] $100 [ ] Other $_____
National Site Development [ ] $25 [ ] $50 [ ] $100 [ ] Other $_____
Disaster Relief Fund [ ] $25 [ ] $50 [ ] $100 [ ] Other $_____
Government Relations [ ] $25 [ ] $50 [ ] $100 [ ] Other $_____
Museum Patron Program Membership [ ] $25/Patron [ ] $50/Supporting [ ] $100/Sustaining [ ] $1000/Life
[ ] Add $4.00 for Model Aviation mailed in a protective covering If you haven’t, please consider naming AMA in your will.
Area of Interest: Please select one area of interest. [ ] RADIO CONTROL [ ] CONTROL LINE [ ] FREE FLIGHT [ ] ROCKETRY [ ] I compete in FAI activities
METHOD OF PAYMENT [ ] VISA [ ] MasterCard [ ] Check enclosed Amount $_________
Card No. __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Exp. Date ____ / ____
Signature _________________________________________
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 may endanger my liability coverage for any damages or claims so caused. I further understand that written notice of the occurrence of any incident must be immediately provided." "I am aware that modeling may present hazards to participants and spectators. I accept, 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."
Signature of Enrollee ______________________________________
Parent or Guardian of Enrollee under age 18 must also sign ________________
Membership ends each year on December 31, regardless of the date a membership form is received. All memberships begin on the day of receipt at AMA Headquarters of a properly completed form and correct dues payment. If a magazine is included with the membership, it begins with the first issue available after the payment is processed. It expires with the issue printed in December (when it is dated January of the following year). Memberships and magazine subscriptions are not transferable. AMA charges a $20.00 fee for returned checks. Any such charges will be added at the time of the membership processing so they may be accounted for. Forms received after September 15 will be processed for membership through the following year.
Transcribed from original scans by AI. Minor OCR errors may remain.
