QUINAPOXET MODEL FLYING CLUB, INC.

APPLICATION FOR MEMBERSHIP

(Note: By providing your e-mail address you agree to have it added to the club mailing list)

NAME: __________________________________ PHONE: ______________________

MAIL ADDRESS: ________________________________________________________

CITY/TOWN & ZIP CODE: ________________________________________________

EMAIL ADDRESS: _________________________________________________________________

AMA/NUMBER: __________EXPIRATION: __________ BIRTHDAY: ____________

TRANSMITTER FREQUENCY(S) USED:____________________________________

INTEREST: SPORT_______SCALE________PATTERN________ELECTRIC_______

PLEASE CHECK ITEM(S):

( ) NEW MEMBER INITIATION FEE: $50.00 (ONE TIME FEE, not Juniors)

( ) FULL MEMBERSHIP: $25.00/YEAR (17 YRS. OLD AND UP)

( ) JUNIOR MEMBERSHIP: $6.00/YEAR (UNDER 17 YRS. OLD)

( ) WOULD YOU BE INTERESTED IN AN OFFICER'S POSITION?

( ) WOULD YOU PARTICIPATE IN CLUB CONTESTS & FUN FLYS?

PLEASE INDICATE YOUR CURRENT STATUS:

NOVICE_____ SOLO_____ PILOT_____ INSTRUCTOR_____

ALL CLUB MEMBERS MUST HAVE THEIR VALID AMA MEMBERSHIP CARD IN THEIR POSSESSION WHILE FLYING.

ALL CLUB FLYING RULES STRICTLY ENFORCED.

90 DB SOUND LIMIT ON ALL MODELS AT 9FT!!

APPLICANT SIGNATURE ________________________________________________

TODAYS DATE _________________________________________________________

PLEASE COMPLETE THIS FORM WITH A PHOTO COPY OF YOUR CURRENT AMA CARD AND RETURN WITH PAYMENT TO:

Rick Bedell

18 Leslie Road

Worcester, MA 01605-1026

PLEASE MAKE CHECKS PAYABLE TO: QUINAPOXET MODEL FLYING CLUB, INC.