2022 Salem R/C Pilots Association Membership Application
Salem R/C Pilots Association
P.O. Box 13214
Salem, Oregon 97309-1214
New Renewal ______________________________
Today's Date (mm/dd/yyyy)
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First Name Last Name Date of Birth (mm/dd/yyyy)
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Address City State Zip
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Home Phone Cell Phone
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E-mail AddressWork Number (Optional)
______________________________ Pending
AMA Number (Check if applied, but not received)
Do you already have a club badge: Yes No
Additional information you would like to provide: (i.e. Instructor/ Builder/ Sport Pilot/ Lawn Mower Repair Person/Giant Scale Pilot/ Manufacture/ Electric Flyer/ etc.) _________________________________________
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Please calculate your dues below.
Family/Adult Dues: $75.00 + $3.25 PayPal Service Fee
Members Under 19: $30.00 + 3.25 PayPal Service Fee
This box for Officer use only
Please initial
( ) Cash ( ) Check
Check Number __________
Amount Paid __________
Date Paid __________
If mailing, make checks to Salem R/C PilotsAssociation and mail this form to:
Salem R/C Pilots Association, Treasurer
P.O. Box 13214
Salem, OR 97309-1214