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PARK PILOT PROGRAM ENROLLMENT FORM


Please type or print the information clearly in CAPITAL letters. One individual per form. When completed, mail this form with payment to the Academy of Model Aeronautics, 5161 E. Memorial Dr., Muncie, Indiana 47302-9252.


Park Pilot PROGRAM Membership $38 (includes print and digital editions of Park Pilot magazine)


Mr. Mrs. Ms. First Name: ___________________________________________________ Initial: __________


Last Name: ________________________________________________________________________________________ Mailing Address: ____________________________________________________________________________________ _______________________________________________________________________________________________ Phone: (___________) _______________________________________________________________________________ Email: _____________________________________________________________________________________________ Birth Date: (mm/dd/yyyy) __________/__________/__________ PAYMENT OPTIONS: Check enclosed: $________ OR Charge my:


P VISA MasterCard Discover $________


Card Number: ___ ___ ___ ___ – ___ ___ ___ ___ – ___ ___ ___ ___ – ___ ___ ___ ___ Exp. Date: ____ / ____ Cardholder’s Signature: _______________________________________________________________________________


Recruiter Information: If you were recruited to join the AMA by a member, AMA club or hobby shop, please indicate only one and list the name and AMA number so we can thank them.


Member Club


Name ____________________________________________ AMA # ____________________________ Name ____________________________________________ Club Charter # ______________________ Hobby Shop Name ____________________________________________ AMA # ____________________________


PARK FLYER SAFE OPERATING RECOMMENDATIONS • ,QVSHFW \RXU PRGHO EHIRUH HYHU\ ÀLJKW WR PDNH FHUWDLQ LW LV DLUZRUWK\ • Be aware of any other radio frequency users who may present an interference problem.


• %H FRXUWHRXV DQG UHVSHFWIXO RI RWKHU XVHUV RI \RXU VHOHFWHG ÀLJKW area.


• Choose an area clear of obstacles and large enough to safely DFFRPPRGDWH \RXU À\LQJ DFWLYLW\


• Make certain this area is clear of friends and spectators prior to launching your aircraft.


• %H DZDUH RI RWKHU DFWLYLWLHV LQ WKH YLFLQLW\ RI \RXU ÀLJKW SDWK WKDW FRXOG FDXVH SRWHQWLDO FRQÀLFW • &DUHIXOO\ SODQ \RXU ÀLJKW SDWK SULRU WR ODXQFK • Abide by any and all established AMA National Model Aircraft Safety Code items where applicable and appropriate.


PARK FLYER DEFINITION


Park Flyer models will weigh 2 pounds or less and be incapable of UHDFKLQJ VSHHGV JUHDWHU WKDQ PSK 7KH\ PXVW EH HOHFWULF RU UXEEHU powered, or of any similar quiet means of propulsion. Models should EH UHPRWHO\ FRQWUROOHG RU ÀRZQ ZLWK D FRQWURO OLQH UHPDLQ ZLWKLQ WKH SLORW¶V OLQH RI VLJKW DW DOO WLPHV DQG DOZD\V EH VDIHO\ ÀRZQ E\ WKH operator. A Park Flyer site can be either an outdoor or an indoor venue. :KHQ À\LQJ DW VLWHV VSHFL¿FDOO\ GHVLJQHG IRU 3DUN )O\HUV WKH SLORW ZLOO NHHS WKH PRGHO ZLWKLQ WKH HVWDEOLVKHG ÀLJKW ERXQGDULHV RI WKH ¿HOG Members need to take into consideration several factors including piloting ability, weight, size, and speed of the Park Flyer model to GHWHUPLQH LI D 3DUN )O\HU VLWH LV DQ DSSURSULDWH YHQXH IRU À\LQJ D SDUWLFXODU PRGHO 7KH WHVW VKRXOG EH ³&DQ , À\ WKLV PRGHO VDIHO\ DQG TXLHWO\ DW WKLV À\LQJ VLWH"´


Please read and sign this declaration. Forms without signatures will be returned. 1RWH 7KLV ZDLYHU PHDQV WKDW LI , DP LQYROYHG LQ DQ\ FODLP RU VXLW , ZLOO QRW VXH WKH $0$ ,QF , XQGHUVWDQG WKDW WKLV ZDLYHU GRHV QRW DIIHFW P\ OLDELOLW\ LQVXUDQFH FRYHUDJH


“I agree to comply with the AMA Park Flyer Safe Operating Recommendations for all applicable model operations. I understand that my failure to comply may endanger my liability coverage for any damages or claims so caused. I further understand that written notice of the occurrence of any incident must be immediately provided.”


“I am aware that modeling may present hazards to participants and spectators. I exempt, waive, and relieve the Academy of Model Aeronautics, Incorporated (AMA) from all current or future liability for personal injury, property damage, or wrongful death caused by negligence.”


Signature of Enrollee _______________________________________________________________________________________________


,QVXUDQFH FRYHUDJH LV HIIHFWLYH RQ WKH GDWH RI UHFHLSW DW $0$ +HDGTXDUWHUV RI D SURSHUO\ FRPSOHWHG HQUROOPHQW IRUP DQG FRUUHFW GXHV SD\PHQW $OO PHPEHUVKLS EHQH¿WV EHJLQ RQ WKH GD\ D SURSHUO\ FRPSOHWHG IRUP DQG FRUUHFW GXHV SD\PHQW DUH UHFHLYHG DW $0$ +HDGTXDUWHUV ,I D PDJD]LQH LV LQFOXGHG ZLWK WKH PHPEHUVKLS LW EHJLQV ZLWK WKH ¿UVW LVVXH available after a correct current form and payment are received. Membership rates and insurance limits are those in effect at the time of printing. Actual cost of dues and amount of insurance coverage is subject to change. Any such change will be noted at the time of membership processing so they may be accepted or not.


(PDLO KDV SURYLGHG WKH $0$ ZLWK WKH RSSRUWXQLW\ WR JHW LQIRUPDWLRQ WR RXU PHPEHUV LQ D WLPHO\ FRVW HI¿FLHQW PDQQHU 7KH $0$ RFFDVLRQDOO\ SDUWQHUV ZLWK UHSXWDEOH ¿UPV WR SURPRWH SURGXFWV WKDW ZLOO EHQH¿W ERWK WKH PHPEHU DQG WKH DVVRFLDWLRQ 7KH $0$ GRHV QRW WUDGH RU VHOO HPDLO RU PDLOLQJ DGGUHVVHV ,I \RX ZRXOG SUHIHU WKDW ZH QRW LQFOXGH \RXU name, please check the box(es) below. 3OHDVH GR QRW XVH P\ HPDLO DGGUHVV IRU DQ\WKLQJ RWKHU WKDQ RI¿FLDO $0$ EXVLQHVV


3OHDVH GR QRW XVH P\ PDLOLQJ DGGUHVV IRU DQ\WKLQJ RWKHU WKDQ RI¿FLDO $0$ EXVLQHVV


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