Application

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JACKSON RADIO CONTROL CLUB INC.

2017 MEMBERSHIP APPLICATION / RENEWAL FORM

 

PLEASE NOTE: DUE TO AMA INSURANCE REQUIREMENTS, ALL APPLICANTS MUST SHOW A CURRENT AMA CARD OR RECEIPT TO     RENEW MEMBERSHIP IN THE CLUB.
Membership Fees are due before March 1, 2017

 

PLEASE PRINT:
             
Name:                                                                                                                  
       
AMA Number:                          
 
Address:                                                                                                             
               
City:                                                                             
 
State:                       
   
Zip:                               
 
Phone:                                                                      
 
Cell Phone:                                   
       
Birth Date:                                                               
               
E-mail Address:                                                                                                   
               

 

BY SIGNING THIS FORM, I AGREE TO ABIDE BY THE RULES AND REGULATIONS OF THE JACKSON RADIO CONTROL CLUB, INC. FAILURE TO DO SO COULD RESULT IN DISMISSAL FROM THE CLUB WITH NO DUES REFUNDED.

 

 

Signature of Applicant:                                                                                                                                                                      

 

Date Signed:                                                                                                                                                                                            

 

DUES ARE TO BE SUBMITTED WITH APPLICATION – AMOUNT PAID $                                 

 

PLEASE MAKE CHECK PAYABLE TO: THE JACKSON RADIO CONTROL CLUB
PLEASE SEND COMPLETED APPLICATION* WITH DUES ATTACHED TO:
Dave Curtis
714 Royal Drive, Jackson, MI 49202
 dcurtis@unisorb.com 517 764-6060
Check here if you don’t have an email address and prefer a postcard for special events.                      

 

What area of club activities will you be participating in?

 

 

 

*Receipt of payment will be sent via e-mail address provided. If you do not have an e-mail address, please include a stamped self-addressed envelope with your application.