HERNANDO
Membership
Application
Please Print
Name:________________________________________ AMA#:________________________
AMA Year:________
ADDRESS:
Street Address:
Home Phone:____________________
Other Phone ____________________
Years in Hobby:_______ AMA
Verified:_________ Amt Pd:_________ Cash Check:________
Circle
One
Channels Used:____________________________
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OPTIONAL INFORMATION
NORTHERN ADDRESS(If
Applicable)
Street Address:
Home Phone:____________________
Other Phone ____________________
Birth Date:__________
Email:_______________________________
Occupation:_______________________
Signed:_______________________________________________
Date:_________________
Annual dues are $40.00. If you wish to become a member,
just print this out, complete the application and
bring it to a meeting. If the
membership cap has not been reached your application will be processed at the
meeting. If the cap has been reached then your application will be added to the
end of the waiting list.
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