Membership Application

Posey Flyers Model Aircraft Club

Date of Application _____________

Name ___________________________________________

Address _________________________________________

City, State, Zip Code _______________________________ Home telephone # (____) ___________

E-Mail __________ @ ___________

Current AMA Member ?_____(Y/N) AMA number (or enter pending) __________________

Class desired Open_____ Junior ______ Associate

Dues $30.00 ____ $10.00 ______ $ _____

Application and dues received by ______________________ (Board member) Date ___________

Date forwarded to Secretary __________