Jefco Aeromod’lers RC Club #176 Online membership Renewal or New member registration Membership is valid from January 1 – December 31. Membership_Registration First Name * Last Name * Email Address * (required to receive electronic newsletters) Confirm Email Address * Confirm Email Phone number * (Primary number) Optional 2nd phone number (Cell or other) Birthday * JanFebMarAprMayJunJulAugSepOctNovDec Month Day * Day Year * Year Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip Zip Address *AMA membership is required for club membership. If you have not applied for AMA membership, you can do so online at www.modelaircraft.org. You will receive a temporary card until your official AMA number/card is issued. If you have applied for AMA membership and have not yet received your AMA number, write “In Progress” in the box below. Membership Types * New (includes $25 club initiation fee) $75 Adult Member (prorated after July 1 = $50) - (see note 1) $40 Junior Member - under 19 yrs of age (see note 1) $40 Associate Members -out of state (see note 2) Renewal $50 Adult Member (see note 1) $15 Junior Member - under 19 yrs of age (see note 1) $15 Associate Member - out of state (see note 2) Life $750 Life Membership (see note 1) AMA Number * Note 1: All club privileges for member and family. One vote per member. Note 2: No voting privileges Additional Member information - Optional Check box to add an additional Family member - $15 First Name (Additional member) Last Name (Additional member) Email (Additional member) (required to receive electronic newsletters) Confirm Email (Additional member) Confirm Email AMA Number (Additional member) READ AND CLICK Below - * I hereby request membership in the Jefco Aeromod’lers RC Club #176. READ AND CLICK Below - * I have read and understand the Field Safety Operations Guidelines as outlined in the Field Safety & Operations Manual (available at the flying field, club meetings, website or any board member). READ AND CLICK Below - * I understand that I must have current Academy of Model Aeronautics (AMA) membership for approved membership in the Jefco Aeromod’lers RC Club. If I am not already an AMA member, I will immediately apply (www.modelaircraft.org). I understand that AMA membership includes valuable liability insurance coverage for accidents involving model airplanes. READ AND CLICK Below - * I agree to fully display my club name badge and AMA card on my body while at the flying field. READ AND CLICK Below - * I agree by checking and signing with my initials below, I acknowledge I have read and will abide by the flying field rules. Please enter your initials below * reCAPTCHA Total $ An email will be sent to you confirming your membership and receipt of your fees. If you do not receive a confirmation email, check your SPAM folder or your membership application was not completed. If you are human, leave this field blank.