NEW JERSEY PINE BARONS RADIO CONTROL CLUB INC.

2005 Membership Application

(Effective Jan 1 2005 to Dec 31 2005)

 

 

 

Member # _________    (Will be assigned)

 

Please print using all capital letters

 

Name: ____________________________                                         Date: _______________________________

 

Address: __________________________                                          AMA # _____________________________

 

City: _____________________________                                          Home Phone: ________________________

 

State: ___________ Zip: _____________                                           Email: ______________________________

 

Please list R/C channels that you currently use: _______            _______      ______     ______     ______    

 

 

 

 

 

    AFFIX PHOTOCOPY OF

 

          AMA CARD HERE
 
YEAR 2005 DUES:

 

Open Membership: (19-65)

    ($50.00)

 

Senior Membership: (over 65)

    ($40.00)

 

Junior Membership: (under 19)

     ($15.00)

 

 

Mail check or money order with

      Completed application to address below:

 

 

 

                        2005 Membership

                        Jerome Gayster

                        123 Farnwood Road

                     Mt. Laurel, NJ 08054

 
 


Payment can only be made by:

Check or Money Order                                               

CASH WILL NOT BE ACCEPTED

 

Make check or Money Order payable to:

N.J. Pine Barons R/C Club

 

Date of Birth: _____________________

 

NOTE: Please send a self address envelope (with stamp) and your membership card will be mailed to you.  Please send an extra copy of your AMA card to be laminated to your club card.

 

If you have any questions please call: Jerome (Jerry) Gayster 856.778.0104.