Name (Last, First)

Street Address                                                                                           City, State and Zip Code

Home or Emergency Phone #                                                                    Cell Phone # (optional)

E-mail Address                                                                                          AMA Number

Please Check Box(s)		Please Enter Amount(s) Paid
	Adult Field Permit ($30)
	Youth Field Permit ($5)
	Frontier Flyer’s Donation*
	Total Paid**
Donations are used for AMA charter fee and other club expenses
$10 per member would be very helpful!
**Make checks payable to Frontier Flyers

 

I request membership to Frontier Flyers.  I’ve enclosed a photocopy of my current AMA membership card and $30.00 ($5.00 youth) as payment for the current year’s dues payable to Frontier Flyers.  I further agree to all the rules and regulations of Frontier Flyers and the AMA by my signature below.

Signature of Applicant                                                       Today’s Date

 

Mail this form and your check with a photocopy of your AMA membership card to:

Charlie Gilligan

425 North Clarmar

Fremont NE 68025      

 

YOUR FIELD PERMIT WILL BE MAILED TO YOU VIA U.S. MAIL, OR ATTEND ONE OF OUR MONTHLY MEETINGS FOR IMMEDIATE POSSESSION.