MAHONING COUNTY MODEL CLUB

2001 Membership Renewal Application

NAME_________________________________________________ DATE_______________

                      (last)                            (first)

ADDRESS___________________________________________________________________

CITY_________________________________ STATE____________ ZIP _______________

TELEPHONE______________________________ AMA#___________________________

SIGNATURE_______________________________ SPOUSE_________________________

            If new members do not have AMA# when joining the club, they must submit the # ASAP!!

Type of Membership (please check one)

DUES

_____ Senior Citizen (over 60 by July)                                                                             $20.00

_____ Junior (not over 15 by July)                                                                                    FREE

_____ Senior (15 but not 19 by July)                                                                                 $10.00

_____ Open (over 19 by July)                                                                                            $30.00

_____ Family membership (wives and or other adults living at the same

            address listed above and being in the same family.                                                 $5.00/member

                                 Signature_______________________________  AMA#_______________

Dues Will Not Be Accepted Without This Form

Make checks payable to: MAHONING COUNTY MODEL CLUB

Please circle your frequency numbers

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Revised 3/14/01 (http://mcmodelclub.freeservers.com/)