Colby RC Flyers
Application for __________(calendar year) Membership
(Please print, complete and submit a form for each
individual separately)
NOTE: Colby RC Flyers membership ends each year on
December 31, regardless of the date a membership application with dues is
received. Applications with dues
received after October 1 will be valid for the remainder of that year and all
of the following year. (This mimics the AMA ‘s policy)
____New
Membership
____Annual Renewal ____ Information Update
First Name:
_____________________________
Last Name:______________________________
Address:
_________________________________ City: ______________State: ___ Zip: ________
Home Phone: __________________
Office Phone: __________________ Cell: _______________
E-Mail Address:
_________________________________________
( ) Individual Membership: Annual Dues $25.00
( ) Additional Household Member (Spouse,
Youth/Under age 18, est.): Annual Dues $10.00
( ) Colby High School Technical Students
Association ( )Member
under age 18 ( )Adviser: Free Annually
Current AMA Individual
Membership # _________________ (required to fly at CRCF field)
Show your AMA membership card
to the CRCF Member receiving this form and have them sign here to verify
______________________________
If not a current AMA
member:
(__) Yes I have submitted an
application to AMA. Date submitted:
____/____/____
(__) No I have not submitted
the application but I will to allow me flying privileges.
(When you receive your AMA
card, show it to the recipient of this form for there verification)
Total Enclosed or given to the recipient of this form: $__________ (___) Check (___) Cash
Please make check payable to Colby RC Flyers and
mail or hand deliver this form with payment to: Marvin Farmer, 120 Experiment
Farm Road, Colby, KS 67701, 785-460-7767, mfarmer@st-tel.net
I have read and understand the
Colby RC Flyers By-Laws and the AMA Safety Codes and I hereby agree to comply
with all AMA Safety Codes and Colby RC
Flyers By-Laws that currently exist and that might be amended in the
future. I am aware that model aircraft
operation presents hazards and I EXEMPT
AND HOLD HARMLESS, CRCF, it’s OFFICERS AND MEMBERS and VIC MAZANEC from all
liability including injury, property damage, or death caused by me or my
guest’s actions, or otherwise on CRCF’s property.
________________________________ ____/____/____ ___________________________
Applicants Signature Date Signed Parent/Guardian Signature
of Applicant under age 18
________________________________ ____/____/____
Receiving Member’s Signature Date Signed
(Last updated: 1/17/05)