Enrollment form for Membership
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.
One-Year Memberships Two-Year Memberships
OPEN MEMBERSHIPS
Adult (New & Renewing) • For adults 19 or over as of July 1, 2016. • Includes subscription to Model Aviation magazine.
□ Choose Adult $75.00 □ Choose Adult $140.00
Senior (New & Renewing) • For adults 65 or over as of July 1, 2016. • Includes subscription to Model Aviation magazine.
□ Choose Senior $65.00 □ Choose Senior $120.00
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 $38.00 □ Choose Extra Family $70.00
Current Open Member’s Name and AMA #
Included Magazine Options Open Adult and Senior memberships include a subscription to Model Aviation magazine.
Choose magazine delivery method
□ Print □ Digital □ Both ($9.95) □ Print □ Digital □ Both ($19.90)
You may choose to receive your print magazine in a protective plastic wrap.
□ Protective wrap ($4.00) □ Protective wrap ($8.00)
Extras You may add a subscription to Park Pilot magazine, a quarterly publication covering small-field and indoor electric aircraft.
□ Print (1-Year) $9.95 □ Print (2-Year) 19.90 □ Add Free Digital Edition (Print subscription required)
You may subscribe to one or two years of Park Pilot magazine regardless of the length of your Open membership.
You may choose to receive your print magazine in a protective plastic wrap.
□ Protective wrap (1 Year) $2.00 □ Protective wrap (2 Year) $4.00
Membership option amt: Magazine amt: Extras amt: Total:
STOP Open membership enrollment complete. Go to section #3.
PARK PILOT
Park Pilot (New & Renewing) • For adults 19 or over as of July 1, 2016. • Includes subscription to Park Pilot magazine.
□ Choose Park Pilot $38.00 □ Choose Park Pilot $70.00
□ Free Digital Edition
Receive the digital edition of Park Pilot magazine as well as the print edition.
Park Pilot membership is for aircraft 2 pounds or less that fly 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.
You may choose to receive your print magazine in a protective plastic wrap.
□ Protective wrap ($2.00) □ Protective wrap ($4.00)
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.
□ Print (1-Year) $36.00 □ Digital (1-Year) $36.00 □ Both (1-Year) $45.95
□ Print (2-Year) $72.00 □ Digital (2-Year) $72.00 □ Both (2-Year) $91.90
You may subscribe to one or two years of Model Aviation magazine regardless of the length of your Park Pilot membership.
You may choose to receive your print magazine in a protective plastic wrap.
□ Protective wrap (1 Year) $4.00 □ Protective wrap (2 Year) $8.00
Membership option amt: Magazine amt: Extras amt: Total:
STOP Park Pilot membership enrollment complete. Go to section #3.
YOUTH
Free Youth For children and young adults under 19 as of July 1, 2016.
□ Choose Free Youth (FREE)
Extras
Youth extras: Enjoy the entire hobby with Model Aviation magazine.
□ Print ($15.00) □ Digital ($15.00) □ Print & Digital ($19.95)
Receive your magazine in a protective cover wrap. □ $4.00
Youth extras: Learn about park flying with Park Pilot magazine.
□ Print ($9.95) □ Add Free Digital Edition (Print subscription required)
Receive your magazine in a protective cover wrap. □ $2.00
Extras amt: Total:
STOP Free Youth membership enrollment complete. Go to section #3.
AFFILIATE
Affiliate • (For non-U.S. permanent residents) • Insurance and competitive privileges only while flying in the USA.
□ Choose Affiliate $36.00 □ Choose Affiliate $68.00
Extras You may subscribe to one or two years of the digital edition of Model Aviation magazine regardless of the length of your Affiliate membership.
□ Digital (1-Year) $36.00 □ Digital (2-Year) $72.00
STOP Affiliate membership enrollment complete. Go to section #3.
3. Support the AMA Foundation
Scholarship Fund
□ $25 □ $50 □ $100
□ Other: $________
AMA Site Development
□ $25 □ $50 □ $100
□ Other: $________
Club Support
□ $25 □ $50 □ $100
□ Other: $________
Government Relations
□ $25 □ $50 □ $100
□ Other: $________
General Fund
□ $25 □ $50 □ $100
□ Other: $________
Museum Patron Program
□ $25/Patron □ $100/Supporting
□ $1,000 / Life
Donation 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 are subject to 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: __________________________________________
