General Information

Name _______________________________________________________________________________

Street Address________________________________________________________________________

Apt./Suite/Box ____________ City ______________________ State ______ Postal Code ______________

Home Phone (        )______-__________ Work Phone (        )______-___________

Birthdate ________________________________________

Occupation ______________________________________

e-mail address ___________________________________ (fully qualified)

Club Related Information

AMA Number _______________________ (you MUST already have or apply for an AMA membership)

Member Type: (circle only one)            General            Family          Associate

Skill Level: (circle at least one)              Beginner       Novice       Intermediate      Expert

Helicopter Specific Information

Models
Manufacturer(s) __________________________________________________________________________

Engine
Manufacturer(s) ___________________________________________________________________________
Size(s) __________________________________________________________________________________

Radio
Manufacturer(s) ____________________________________________________________________________
Type(s) __________________________________________________________________________________
Frequencies ______________________________________________________________________________

Comments

_________________________________________________________________________________________

_________________________________________________________________________________________

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