Northern Connecticut Radio Control Club
MEMBERSHIP APPLICATION
New members are subject to a one-time “initiation” fee (see notes below)						Please Check one:
NCRCC renewal membership fees are due as of September 1 of each year.  Renewal Fees must be received prior to the end of the October meeting; otherwise late applications will be treated as a new membership (subject to the initiation fee shown below).						New Member  o
						Renewal       o
List Radio Frequencies you operate by channel number:
Applicant Information:				Date:_________________   (MM/DD/YYYY)
Name:						AMA #:______________
Address 1:						Jr.___  Sr.___  Open___
Address 2:
City, State Zip:						Date of Birth for (AMA Verification)
Telephone Number:			(              )
E-mail ID:						___________________
Sponsor Signature:						(MM/DD/YYYY)
Types of Membership and Dues - Please Check One:
	Single Senior Membership - 17 year old and over, $36.00 per year ($3.00 per month)
	Single Junior Membership - 16 year old and under, $12.00 per year ($1.00 per month)
	Family Membership - living at same Address.
Notes:	1. New Member initiation fee is:  $50.00.
	2. Maximum for Family Membership is: $48.00 a year
Please List Family Members Below:
Name:					AMA Number:
Name:					AMA Number:
Name:					AMA Number:
SAFETY DECLARATION:
All NCRCC members must sign the “Safety Declaration” annually. Applications will not be accepted without a signature below.
Applicant Certification:  I agree to abide by the NCRCC club rules, by-laws
and the AMA Safety Code.
___________________________________
Signature of Applicant
MAIL RENEWALS AND PAYMENT TO:				NEW MEMBERS MUST APPLY IN PERSON at an NCRCC meeting. If there are circumstances which prevent you from applying in person, send an application to the address to the left describing your circumstances and your application will be presented at a meeting.
N.C.R.C.C.
P.O. Box 443
Ellington, CT  06029-0443