AWAM Membership Application 

Name    

 First:                   MI:    Last:                                

Company (if business address):

Title (if business address):
Address:                                                                  

___ home address
___ business address

City: State or Prov: 

Zip or mail code:

 Country:

Home Phone:

Work Phone:

Fax:

E-mail:

Your aviation interests, affiliations and employer: (optional)

                Type of Membership:  (All amounts in U.S. dollars.  Add $10 if outside the U.S.A.)

___  Individual ($25.00/yr)

___ Student ($15.00/yr)

___ Educational Institution ($150.00/yr)

___ Corporate ($300.00/yr)

 ___ Life time ($500.00/one time only)
 
Name on Credit card

Visa or MasterCard (circle one)
Credit card No.    Exp.

I hereby certify that the information on this application is true and correct.

Signed:

Date:

  Memberships and donations are tax deductible.  
Amount from AWAM product order form                        
Donation  
Total amount enclosed  

Please print a copy of this application and mail with a check, money order or credit card info to:
(credit card orders may be also be faxed)

AWAM
P.O. Box 1030
Edgewater, FL 32132-1030
 386-428-3534 (fax)

Show your support with the purchase of AWAM products!