PRYOR PROP BUSTERS MEMBERSHIP APPLICATION

                            Please fill out completely

                                   Please Print


Date:__/__/__


Name: ________________________________________ Phone:# (___)___-____ AMA:# _____________

Address:_________________________________Apt #____ City: ______________________ 

State: __ Zip: _____ Birth Date: __/__/____ 

E-Mail Address if any:_____________@________________ 

Can you access the Newsletter via the Web Site ?__Yes__No

Channel numbers you will use: __,__,__,__,__,__

Membership Dues:

   Type of membership applied for:

   Renewal ($100 per year, or $10 per month if under 3 years in the club)  
           ($50 per year if over 3 years in the club)

   New member ($30 if paying by the month, or $120 if paying by the year)  
              (includes club hat, AMA name tag, and first month's dues)

   Junior member FREE if flying with a member. (Must be under 16)

   Aux. Field Privileges $10.00 per month

   You will be asked to mow at least once during the membership year unless you have asked for a mowing waiver.
   
   Mowing Waiver $40.00 (must Pre-register with Jack Macy).

Total Amount Paid: $___.__


I understand and will abide by all of the rules of AMA and the Pryor Prop Busters.



Signature: ____________________________________________


Mail to: Pryor Prop Busters
         Attn: Richard Milius
         320 S.E. 15th. Street
         Pryor, Ok. 74361