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) _______________
[ ] I have 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
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 exempt, waive, and relieve the Academy of Model Aeronautics, Incorporated (AMA) from all claims for negligence 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 membership benefits begin on the day of receipt at AMA Headquarters of a properly completed form and correct dues. If a magazine is included with the membership, AMA will begin sending the magazine with the first issue after a correct current form and payment are received; it expires with the issue printed in December (which is the last issue of the following year). Membership in AMA is a privilege. Any membership that is not properly received may be subject to review and acceptance by AMA. Any membership card or magazine not received after September 15 will be replaced at no charge. All dues are in U.S. funds; foreign memberships require an additional fee for postage. Refunds will be made only if requested within 60 days of the date of receipt.
Transcribed from original scans by AI. Minor OCR errors may remain.
