Suburban RC Barnstormers
Membership Application/Renewal

Date: ____________________    Amount Paid: _______________

Primary member name: _______________________________________________

Address: ___________________________________________________________

City: ______________________________________________________________

State: _________________________   Zip Code: _______________________

Home Phone: _____________________   Work Phone: ____________________

Email: _____________________________________________________________

AMA #: ___________ (required to fly)  Birth date (Sr/Jr): __________

RC Channels of Operation: __________________________________________

Skill Level:  Beginner ____     Intermediate ____     Advanced _____

Type of membership:

    Junior (age 17 and below) ____           Adult individual ____

    Senior Citizen (age 65 and above) ____   Family ____

Family members: ____________________________________________________

____________________________________________________________________


I have included an additional $3.00 for each name badge: ____
(indicate badge names)

I prefer to receive my newsletter via email: ____

I agree to accept and abide by the AMA and Forest Preserve District
of Dupage County rules and regulations concerning the handling and
flying of my model aircraft.



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Signature