TRI-COUNTY SKY BARONS
Mifflintown PA
Radio Control Model Club    -    Membership Application

First Name    Initial 
Last Name DATE  
Address
City
State                   ZIP  
Home Phone
Work Phone
Mobile Phone
E-Mail
Radio Channels Used DSM
AMA Number
Regular Membership $ 25.00     (18 years of age to 65 years of age by January 1)
Senior Membership $ 15.00     (65 years of age and over by January 1)
Junior Membership $ 15.00     (18 years of age and younger by January 1)
Associate Membership $ 25.00     (Not permitted to operate Radio Controlled Models or Equipment.)

I allow Tri-County Sky Barons to use the following information on the club web site:
Name      Address      Home Phone      Work Phone      Mobile Phone      E-Mail Address

Applicable fees must accompany this application.
Please read and sign this declaration. Applications without signatures will be returned.
Proof of AMA membership must be produced before you will be permitted to operate Radio Controlled Equipment. (Exception: Those enrolled in the Club Sanctioned Training Program and under the direct supervision of the Introductory Program Instructor may be temporarily exempted from this requirement.)

Tri-County Sky Barons is an Academy of Model Aeronautics Radio Control Club.

NOTE: This waiver means that if I am involved in any claim or suit I will not sue the Tri-County Sky Barons. I understand that this waiver does not affect my liability coverage.

I agree to comply with the AMA Safety code for all applicable model operations. I understand that my failure to comply with the Safety Code may endanger my liability coverage for any damages or claims so caused. I also understand that written notice of the occurrence of any incident must be immediately provided.

I also agree to abide by the By-Laws of the Tri-County Sky Barons and I am aware that modeling my present hazards to participants and spectators. I exempt, waive, and relieve the Tri-County Sky Barons from all current or future liability for personal injury, property damage, or wrongful death caused by negligence.

Signature of applicant:  ________________________________

                            Print:  ________________________________  

Signature of Parent or Guardian of applicant under age 18:

                                       ________________________________

                            Print:  ________________________________

     Mail to: Tri-County Sky Barons
     673 Laurel Run Road Mifflintown PA 17059

REV: 071111