AMA Membership Application
ACADEMY OF MODEL AERONAUTICS Application for 2009 - One Individual Per Application
Please type or print the information clearly in CAPITAL letters. When completed, this form can be mailed with payment to AMA, 5161 E. Memorial Dr., Muncie, Indiana 47302-9252, Fax: (765) 741-0057, www.modelaircraft.org
Mr. ___ Mrs. ___ Ms. ___
First Name _____________________ Initial _____ Last Name ___________________________
Mailing Address (number and street) ________________________________________________ Apt. # _______
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 #: ______________
MEMBERSHIP CATEGORIES:
For those 19 or over as of July 1, 2008
OPEN Membership $58.00 Model Aviation included. (date of birth required) ___________________ (Those 65 or over by July 1, 2008 may take a $10.00 deduction in dues.)
EXTRA Family Membership $30.00 (Applies to any one adult who resides in the same household as a current OPEN member.) (Magazine not included. List current OPEN member's name and AMA number.) _______________________________
PARK PILOT PROGRAM* $29.95 (Park Pilot magazine included) (date of birth required) ___________ *Aircraft must not exceed 2 pounds, 60 mph, and may not be powered with an internal combustion engine. Does not have voting rights, can not compete in competitions, and has reduced liability insurance and no accident/medical insurance.
For those under 19 as of July 1, 2008
YOUTH Membership $15.00 (Model Aviation included) (date of birth required) ___________________
YOUTH/NO MAGAZINE Magazine not included $1.00 (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 Aero Club ________________________ Expiration date ___________
AFFILIATE MAGAZINE SUBSCRIPTION to non-US address - add $60.00 for a total of $88.00.
For Canadian Residents AMA has a reciprocal agreement with MAAC. A current MAAC card will be honored at all sanctioned events or chartered club activities. For Canadians desiring AMA membership in addition to MAAC, choose either Open or Youth membership categories listed above. An additional $24.00 postage and handling is required for magazine delivery outside the United States. Please list current MAAC number and expiration date: _________________________________
OPTIONS:
- Museum Patron Programs
- Museum Patron $25.00
- Supporting $100.00
- Sustaining $500.00
- Life $1,000.00
- Donation ________
- Add $4.00 for Model Aviation mailed in a plastic protective covering.
[ ] FOR OFFICE USE ONLY
Control Line
- Aerobatic Scale
- Carrier Speed
- Combat Sport
- Racing Electric
Free Flight
- Indoor
- Outdoor
- Scale
Radio Control
- Electric Indoor
- Electric Outdoor
- Scale
- Giant Scale
- Helicopter
- Pattern
- Pylon
- Combat
- Park Flyer
- Sport
- Jet
- Soaring
Rocketry I compete in FAI activities
PAYMENT OPTIONS: Check enclosed $ ________ Charge my ___ VISA ___ MasterCard $ ________ Card No. ____________________________ Exp. date ______ Cardholder's signature _______________________
Please read and sign this declaration. Applications without signatures will be returned.
"I agree to comply with the AMA Safety Code or AMA Park Flyer Safe Operating Recommendations for all applicable model operations. I understand that my failure to comply with the Safety Code or AMA Park Flyer Safe Operating Recommendations 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 model aviation may present hazards to participants and spectators. I, exempt, waive, and relieve the Academy of Model Aeronautics, the incorporated (AMA) from all current or future liability for personal injury, property damage, or wrongful death caused by negligence."
Signature of Applicant ___________________________ Parent or Guardian of Applicant under age 18 must also sign _______________________
Insurance coverage is effective on the date of receipt at AMA Headquarters of a properly completed application and correct dues payment. Membership ends each year on December 31, regardless of the date a membership application is received. Applications received after September 15 will be valid for the remainder of that year and all of the following year. If a magazine is included with the membership, it begins with the first issue available for the year after a correct current application and payment are received. Membership rates listed are in U.S. dollars. Claims for insurance must be reported to the AMA in writing and will be processed in accordance with the terms and conditions of AMA insurance policies. AMA does not sell or trade its membership list. From time to time AMA may contact you about AMA business and services. If you do not want to be contacted by mail or telephone for AMA business, please check the appropriate box below.
[ ] Please do not use my E-mail address for anything other than official AMA business. [ ] Please do not use my mailing address for anything other than official AMA business.
ONLY ONE APPLICANT PER FORM See Back for AMA Safety Code and AMA Park Flyer Safe Operating Recommendations
Transcribed from original scans by AI. Minor OCR errors may remain.
