WHITE HILLS EAGLES R. C. CLUB, INC.
AMA # 4567
APPLICATION FOR CLUB MEMBERSHIP

First Name ___________________Middle Initial ______ Last Name _______________________

Mailing Address: _______________________________________________________________

City _____________________________ State ______________ Zip Code__________________

Date of Birth: ______________________ AMA Number: ______________Type______________

Telephone Number: Home ________________ Work ________________Cell _______________

E-Mail Address: ________________________________________________________________

Radio Frequencies currently using: _________________________________________________

Other Clubs currently a member of: _________________________________________________

THE FOLLOWING IS THE CLUBS Safety Code and By Law Compliance statement:

"I agree to comply with the AMA Safety Code for all applicable model aircraft operations and will comply with the By Laws of White Hills Eagles R. C. Club, Inc."

Applicant Signature: _____________________________ Date: _____________

Sponsor Signature: ______________________________ Date: _____________

The Sponsor is required to verify information about the applicant such as AMA membership, etc. The Sponsor then presents this application to the Membership Committee. (The Membership Committee consists of four, Chairmen and three club members in good standing.) The Membership Committee has sole authority to approve or reject the applicant.

Membership Committee Approval Signature: _______________________ Date: _____________

Membership Committee Rejected Signature: _______________________ Date: _____________

Application Fee of $25.00, nonrefundable, must be submitted with this application.

Attach check #_________ payable to White Hills Eagles R. C. Club, Inc.

The Applicant may mail or deliver application to:

Andy Figlar,
Membership Chairman
35 Newtown Avenue
Stratford, CT 06614-1614.