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) $85 Adult Member (prorated after July 1 = $55) - (see note 1) $40 Junior Member - under 19 yrs of age (see note 1) $40 Associate Members -out of state (see note 2) Renewal $60 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 Family Member information - spouse and/or children under 19 years old living in the same household Add an additional family member (same household) - $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) Which Facility Will You Be Using * Flying Field RC Racetrack Both 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 have read and will abide by the Field Safety Operations Guidelines as outlined in the Field Safety & Operations Manual (available at the flying field, club meetings, or club website). Please enter your initials below * Captcha 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. Please allow 2-3 weeks for your membership application to be processed and approved.You will receive pertinent info via regular mail. If you are human, leave this field blank.
