WASATCH AERO MODELERS (WAM) CLUB MEMBERSHIP APPLICATION FORM

Read printable application form instructions prior to printing form. Only one applicant per application form.

ALL PILOTS USING THE WAM CLUB FLYING FACILITY MUST HAVE A VALID WAM AND AMA MEMBERSHIP

NEW MEMBER FEE SCHEDULE and RENEWAL ( Check the appropriate time frames A-C and also D,E, as applicable)

A. JOINING JANUARY 1st: SENIOR ($60.00)___,JUNIOR ($15.00)___,See Notes 1, 2. A. DUE $_____________
(Next years renewal is full dues required for the next year) See Note 3.

B. JOINING AFTER JUNE 30th: SENIOR ($60.00)___,JUNIOR ($15.00)___, See Notes 1, 2. B. DUE $_____________
(Next years renewal is one half the dues required for the next year).See Note 3.

C. JOINING AFTER SEPTEMBER 31st: SENIOR ($60.00)___,JUNIOR ($15.00)___,See Notes 1, 2. C. DUE $_____________
(Member is given three months of free membership), and no dues are required for the next year unless the
dues for that year are increased. And junior membership dues "age" requirements apply for this membership).

D. EQUITY ASSESSMENT FEE: (ALL NEW SENIOR MEMBERS) ($65.00)___.See Note 3. D. DUE $______________

E. ACTIVE MILITARY EQUITY ASSESSMENT: (SEE CLUB SECRETARY FOR DETAILS). E. DUE $______________

TOTAL DUES PAID $_______________

Note 1 Junior Pilot Members are those Members who have not reached their 19^th birthday prior to January 1^st of year membership is applied for.
Note 2 First Junior Pilot membership fee is $15.00 and no additional fee for all other Junior pilot members of the same household, and all additional Junior pilots must apply for WAM membership using this form.

Note 3 Renewal: All renewals are as per above lines A, B, C and D. No Equity Assessment charge for renewals that occur within two Years of last membership.

If renewal is beyond two years of last renewal then a Senior Pilot is required to Repay the Equity Assessment Fee.

Members from the previous year paying their dues after January 31st of the next year shall be assessed a late fee of $5.00.

MAKE CHECK OR MONEY ORDER TO (WAM). IF sending by mail enclose a small self addressed stamped envelope and a copy of your current AMA card to : TERRY PITKIN 958 N. 300 W. SUNSET, UTAH 84015

Please Print application

SENIOR PILOT NAME:______________________________DATE OF BIRTH:_________AMA NO.:_______________

JUNIOR PILOT NAME:______________________________DATE OF BIRTH:_________AMA NO.:_______________

SENIOR PILOT ADDRESS (OR) JUNIOR PILOT GUARDIAN ADDRESS

ADDRESS_______________________________________CITY:______________________STATE:_______________

ZIP CODE___________________PHONE_________________________

E-MAIL ADDRESS:______________________________________________________

Please read and sign this declaration. Applications without signatures will be returned.

Note: This waiver means that if I am involved in any claim or suit I will not sue the WAM, Inc. I understand that this waiver does not affect my liability insurance coverage.

Safety Code Compliance and waiver and release of liability statement.

"I agree to comply with the WAM/AMA Safety Codes 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 further understand that written notice of the occurrence of any incident must be immediately provided to WAM and AMA."

"I am aware that modeling may present hazards to participants and spectators. I exempt, waive, and relieve the Wasatch Aero Modelers (WAM) from all current or future liability for personal injury, property damage, or wrongful death caused by negligence."

Signature of Applicant: ___________________________________________Date:_______________

Parent or Guardian of Applicant under age 19 must also sign:

Signature of Parent or Guardian:_____________________________________Date: _______________