Enrollment form for 2015 Membership
Special Enrollment Offer - Valid until 9/14/2015
Questions?
For help completing this form, contact AMA at (800) 435-9262.
Return completed form to
Academy of Model Aeronautics
5161 E. Memorial Dr.
Muncie IN 47302
Or fax your form to: (765) 741-0057.
1. Contact Information
(Only one individual per form.)
□ Mr. □ Mrs. □ Ms. First Name & Initial Last Name
Mailing Address
(number and street) Apt.#
City State Zip Code Phone
Date of Birth: Email: □ New Member □ Renewal AMA #
(Renewals only - leave blank if unknown)
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).
Recruiter Name: Recruiter AMA #
Primary area of interest (choose only one): □ Radio Control □ Control Line □ Free Flight □ Rocketry
2. Membership Category
(Choose only one of Open, Park Pilot, Youth, or Affiliate memberships.)
All membership categories receive membership, liability and accident/medical insurance, and competitive privileges unless noted.
OPEN MEMBERSHIPS
Adult
(New & Renewing)
• For adults 19 or over as of July 1, 2016.
• Includes subscription to Model Aviation magazine.
□ Choose Adult 1-Year
$58.00
□ Choose Adult 2-Year
$113.00
Senior
(New & Renewing)
• For adults 65 or over as of July 1, 2016.
• Includes subscription to Model Aviation magazine.
□ Choose Senior 1-Year
$48.00
□ Choose Senior 2-Year
$93.00
Extra Family
• For any adult who resides in the same household as a current Open Member.
• Does not include a subscription to Model Aviation magazine.
□ Choose Extra Family $30.00
Current Open Member’s Name Current Open Member’s AMA #
Included Magazine Options
Open Adult and Senior memberships include a subscription to Model Aviation magazine.
Choose a delivery method
□ Print □ Digital □ Both ($9.95)
Protective Wrap
Receive your magazine in a protective cover wrap. □ $4.00
Extras
You may add a subscription to Park Pilot magazine. Park Pilot is a quarterly publication covering small-field and indoor electric aircraft.
□ Print ($9.95) □ Add Free Digital Edition (Print subscription required)
Receive Park Pilot magazine in a protective cover wrap. □ $2.00
Special Offer
Valid until 9/14/15
Total for this section:
Open Membership application complete. Go to section #3.
OPEN MEMBERSHIP TOTAL:
PARK PILOT
Park Pilot
(New & Renewing)
• For adults 19 or over as of July 1, 2016.
• Includes subscription to Park Pilot magazine.
Park Pilot membership is for aircraft 2 pounds or less that flow below 60 mph and does not include voting rights or competitive privileges. Park Pilot membership insurance benefits are limited to $500,000 of liability coverage.
□ Choose Park Pilot
$29.95
Included Magazine Options
Free Digital Edition
□ Receive the digital edition as well as the print magazine.
□ Protective Wrap $2.00
Receive your magazine in a protective cover wrap.
Extras
You may add a subscription to Model Aviation magazine. Model Aviation is the monthly flagship publication of the AMA and offers our most extensive coverage of the hobby.
Choose a delivery method
□ Print ($36.00) □ Digital ($36.00) □ Both ($45.95)
Protect your magazine in a protective cover wrap. □ $4.00
Total for this section:
Park Pilot Membership application complete. Go to section #3.
PARK PILOT MEMBERSHIP TOTAL:
YOUTH
Free Youth
For children and young adults under 19 as of July 1, 2016.
□ Choose Free Youth (FREE)
Enjoy the entire hobby with Model Aviation magazine.
Choose a delivery method
□ Print ($15.00) □ Digital ($15.00) □ Print & Digital ($19.95)
Receive your magazine in a protective cover wrap. □ $4.00
Learn about park flying with Park Pilot magazine.
Choose a delivery method
□ Print ($9.95) □ Add Free Digital Edition (Print subscription required)
Receive your magazine in a protective cover wrap. □ $2.00
Total for this section:
Youth Membership application complete. Go to section #3.
YOUTH MEMBERSHIP TOTAL:
AFILIATE
Affiliate
• (For non-U.S. permanent residents)
• Insurance and competitive privileges only while flying in the USA.
□ Choose Affiliate Membership $28.00
□ Receive Model Aviation Digital Edition (Add $36.00)
Total for this section:
Affiliate Membership application complete. Go to section #3.
AFFILIATE MEMBERSHIP TOTAL:
3. Support the AMA Foundation
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
□ $25/Patron □ $100/Supporting
□ $1,000 / Life
Support Total:
4. Payment
□ Check □ Visa □ Mastercard □ Discover Card No. __________ - __________ - __________ - __________ Exp: ______ / ______
All membership benefits begin on the day a properly completed form and correct dues payment is received at AMA Headquarters. If a magazine is included with the membership, it begins with the first issue available for the year after a correct current form and payment are received. Membership rates and insurance limits are those in effect at the time of printing. Actual cost of dues and amount of insurance coverage may change. Any such changes will be noted at the time of membership processing so they may be accepted or not.
If I am involved in any claim or suit I will not sue the AMA, Inc. I understand that this does not affect my liability insurance coverage. “I agree to comply with the AMA Safety Code.”
Signature: ____________________________________________
Application Total:
$____________
Application Source: P
