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PLEASE PRINT:

FIRST NAME:_______________LASTNAME:__________________________Spouse/Other____________________________________

ADDRESS:_________________________________________________________________________________________________

CITY:_______________________________________STATE:_____________ZIP:_______________________

PHONE: HOME_____________ CELL_______________AMA # ___________DOB____________

_E-Mail_____________________

NOTE: MUST HAVE A VALID AMA CARD.

Dues Structure:

Renewing Adult Membership; $25.00 per year

1st time Membership ($10.00 one time fee); $35.00 first year

Junior Membership (under 16) $ 5.00 per year

Payment: Cash:__________ Check:______________

Make checks payable to FlightMasters of Klamath Falls

Mailing address: FlightMasters of Klamath Falls

P.O. Box 813

Klamath Falls, Or 97601

You will be considered a contributor until you have a valid AMA number.

(This form may be printed for personal use)

As a contributor you will receive the Club newsletter and can participate

in club meetings. Contributor's dues will be the same as full member.

(AMA insurance not VALID until AMA number is issued.)