2007 MEMBERSHIP APPLICATION

AMA CHARTER #963

NAME _______________________________________________________

AMA#______________________________________________________

ADDRESS ___________________________________________________

CITY __________________STATE_______ ZIP_____________________

PHONE (_____)_______________________________________________

E-MAIL ADDRESS ______________________________________________________________

In order to save postage fees, it is desirable for all members to download the newsletter from the club web site
at  LCRC.ORG. Members who cannot download it may have news letter e-mailed to them by checking
here ______.  The newsletter will be sent to the address above.

ADULT   $75        SENIOR $65         JUNIOR $15

NOTE: There will be a $10 late penalty for anyone who has not renewed by the February meeting. Excluding new membres!

Make checks or money orders payable to: "Lorain County R/C Club". Bring completed application, along with current AMA card, to any club meeting, or, mail application, check and photocopy of AMA card to:

Chris Bonner, LCRC Membership Chairperson
4785 Belmont Dr.
Avon, Ohio 44011
Phone (440) 934-1704    email     chrisb@centurytel.net

I CERTIFY THAT I HAVE READ, UNDERSTAND AND WILL COMPLY WITH THE LORAIN COUNTY R/C CLUB BYLAWS AND FIELD RULES, AS WELL AS THE AMA SAFETY CODE.

SIGNED ______________________________________ DATE _____________