VACA VALLEY RADIO CONTROLLERS,  INC,                     2012 FORM      AMA Chapter Club #172

MEMBERSHIP APPLICATION and RENEWAL FORM

Please Print & Fill in Completely    Renewals are due January 1st  & delinquent February 15th

AMA License No.  

Name:  

Street:  

City:                             Zip:               
Telephone:                                                                                

Email Address: 									

Skill Level:    Student / 1-3 Years / 3-5 Years  / 5+ Years 

Interests :  Sport  / Scale /  Helicopter                        

Will you participate in?  Contests  /  Fun Fly’s / Pylon racing  /Combat  / Barbecues                
Annual Renewal  - 18-54 Yrs old.  $90    ($10 Late Fee after Feb 15th)                  $                             55-70  “  “     $70 	 ($10 Late Fee after Feb 15th)                  $                             70 +   “   “    $55    ($10 Late Fee after Feb 15th)                  $ 

New Member ($90.00 Membership (pro-rated) + $100.00 Runway fee:                         $ 

NOTE: New AMA Members get AMA Membership cost deducted from New Member dues

Junior Member 18 Years Old and Under, Dues only  $5. No Runway fee.                     $           
MUST be accompanied by an adult 

TOTAL included										$        

.......................................................................................
DATE:         Renewal:            New member: Yes/No   PAID BY: CASH / CHECK#         .              ......................................................................................
         
Revised 12/19/2011

Mail this form, check, copy of current AMA card and Self Addressed Stamped Envelope to:
Bengt Jonsson						
735 Lotz Way						
Suisun,  CA 94585
707-399-7721