NORTHSHORE R/C CLUB #2489

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					                       NORTHSHORE R/C CLUB
                                    AMA Club #2489

                Membership Application (New and Renewing Members)

                  AMA MEMBERSHIP REQUIRED FOR ALL MEMBERS
                         RENEW YEARLY DUES BY: February 15th

NAME:

AMA Number:                              IMAA Number

Date of Birth

Address:

City:

State:

Zip:

Home Phone

Business Phone

Cell

Email:
Emergency
                                          Emergency Number:
Contact:


Occupation:
                                               $125 Family              $35 Junior
Membership Type:                          (Covers spouse and         (16-20 years old and
AMA Required for all    $100 Standard
types                                     full time students under   must be in school full
                                          21)                        time)
Other Flying
Clubs:
              THANK YOU FOR YOUR MEMBERSHIP!!! SEE YOU AT THE FIELD!!!!


        Please complete this form and mail it along with payment (check) to:

                                 Northshore R/C Club
                                  c/o Wayne LeBlanc
                                  419 Timberlane Dr.
                                   Slidell, LA 70458

          Questions? Contact Wayne LeBlanc at neptune1@bellsouth.net

				
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