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     Winnipesaukee Radio Controllers
           
First Name: _____________________________________ Last Name: _____________________________________

Address: ________________________________________________________________________________________

City:  _____________________________________________ State: ____ Zip: ______ Phone: _____ - _____ - _____

E-Mail Address: __________________________________________ Date of Birth: ___/___/___ 
                              Optional and confidential - E-Mails we be sent for club information                  

AMA Member #: ___________

Please read the AMA rules that bind your membership  http://www.modelaircraft.org/files/105.pdf