Tyler Modelers Club Board

TYLER MODELERS CLUB (TMC) - MEMBERSHIP APPLICATION

Name of Applicant: _____________________________ DOB: ___________

Mailing Address: ________________________________________________

City / State / Zip: _______________________________________________

HomePhone: __________ WorkPhone: ___________ CellPhone: __________

email Address: ____________________________________________________

Please send notifications to me by (please check one): [_] email, [_] US mail

My Current AMA Number: ______________ Expiration Date: _____________

My Application is for: [_] Renewal of My Membership, [_] New Member

Please submit
a completed copy
of this application,
with payment,
to the TMC Treasurer,
or send it to:
Tyler Modelers Club
P.O. Box 9328
Tyler, TX 75711

CHECK MEMBERSHIP DESIRED FEE SCHEDULE NOTES (Club Year is July 1 thru June 30)

[_] Junior Member $10 Per Year Junior Member is 19 years or younger

[_] Regular Member $40 Per Year Regular Member is 20 years or older

[_] Family Membership $55 Per Year
Per Family List Family Members, their AMA numbers, and age:
__________________ AMA # _________ Age: ___
__________________ AMA # _________ Age: ___
__________________ AMA # _________ Age: ___

Circle All
R/C Channels
You Plan
to Use: Spread Spectrum 2.4 GHz (Circle if you use)

72 MHz Channels 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
51 52 53 54 55 56 57 58 59 60

50 MHz Channels
(Ham License Required)
FCC License #: __________
License Type: ___________ RC01 RC02 RC03 RC04 RC05
RC06 RC07 RC08 RC09 RC10
(You must have a copy of your valid FCC license with you)

27 MHz Channels 1 2 3 4 5 6

DECLARATION:
I agree to read and abide by, as a condition for membership in the Tyler Modelers Club, all applicable AMA and TMC rules, including TMC Field & Flying Rules and TMC Bylaws and to any changes or modifications that may be made to them during my membership period. I understand and agree that as a condition of membership, my failure to comply with all applicable safety and flying field rules, and/or failure to conduct myself in a gentlemanly /ladylike manner may result in the revoking of my membership. I also understand that operating model aircraft presents hazards and I EXEMPT AND HOLD BLAMELESS THE TYLER MODELERS CLUB, its OFFICERS, BOARD MEMBERS and MEMBERS from all liability, including personal injury, property damage, and/or death caused by me, or any of my guest's actions.
Signed (by applicant): __________________________________ Date: ___________ Payment ($): ____
Last Form Change: 5/17/2008 (Added 2.4GHz & 27MHz, changed memberships) 

CHECK MEMBERSHIP DESIRED	FEE SCHEDULE	NOTES (Club Year is July 1 thru June 30)
[_] Junior Member	$10 Per Year	Junior Member is 19 years or younger
[_] Regular Member	$40 Per Year	Regular Member is 20 years or older
[_] Family Membership	$55 Per Year Per Family	List Family Members, their AMA numbers, and age: __________________ AMA # _________ Age: ___ __________________ AMA # _________ Age: ___ __________________ AMA # _________ Age: ___

Circle All R/C Channels You Plan to Use:	Spread Spectrum	2.4 GHz (Circle if you use)
	72 MHz Channels	11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
	50 MHz Channels (Ham License Required) FCC License #: __________ License Type: ___________	RC01 RC02 RC03 RC04 RC05 RC06 RC07 RC08 RC09 RC10 (You must have a copy of your valid FCC license with you)
	27 MHz Channels	1 2 3 4 5 6