Member Name:                                                                     Date:                                                

Address:                                                                                                                                        

City:                                                                 State:                             Zip:                                

Home Phone:                                                         Work Phone:                                                    

E-Mail Address:                                                                                                                            

AMA#                                                     Year:                                                   

There are no annual dues to belong to the club, however, a $50 initiation fee is required. In order to enjoy the benefits of the club and flying at the New London Reservoir, you must agree to work the weekend of the annual float fly to maintain your membership.

LIST CHANNEL NUMBERS OF YOUR RADIOS

AM                                                                                                                                                

FM                                                                                                                                                

I agree and abide by the Club Regulations and By-Laws, and by the AMA Safety Code, and that I must be a current member of AMA to fly at the New London Reservoir. I understand that my application must be approved by the Club membership if I am applying as a new member.

Signed:                                                                         Date:                                                        

Signed:                                                                         Date:                                                        
                Parent or guardian of applicant under age 18 must also sign

Officer Signature:                                                         Date:                                                        

Please print out the application and fax to 419-929-3216 or mail to: Firelands Flyers  
                                                                                                 PO Box 93
                                                                                                 New London, OH  44851