2012
NAMBA MEMBERSHIP APPLICATION
THIS FORM MUST BE USED TO APPLY FOR NAMBA INTERNATIONAL MEMBERSHIP
PLEASE NOTE
: Print all information clearly. In the event of an accident, this form becomes a legal form.
Please do not use it for personal notations. Whe re any doubt of spelling of the name or address occurs, the form
will be returned to the maker, and the membership will be held up. Please keep in mind that the member is not
insured until the request and the fee for insurance have been properly filed with an authorized NAMBA official.
Enclosed please find $___________to enroll me in the NAMBA and the Modeler’s Insurance Plan.
NEW MEMBER: _______
EXISTING MEMBER: _______
CURRENT NAMBA #: _______
MEMBERSHIP CATEGORY AND FEES : Adult Member ($45) _____
2
nd
Adult at Same Mailing Address ($35) _____
(Please note: this category does not receive separate mailings)
Junior Under 18 ($25) _____
NAME: ________________________________________________________________________________
STREET ADDRESS:______________________________________________________________________
CITY: ________________________________________ STATE/PROVINCE: _______________________
COUNTRY: ___________________________________ ZIP/POSTAL CODE________________________
HOME PHONE NUMBER (Include Area Code): _______________________________________________
CELL PHONE NUMBER (Include Area Code): ________________________________________________
EMAIL ADDRESS: ______________________________________________________________________
CLUB AFFILIATION (If Applicable): _______________________________________________________
SPECIFIC AREAS OF INTEREST (e.g. OUTBOARD, GAS, COMBAT, ETC): ______________________
I WOULD LIKE TO PAY BY CREDIT CARD (
VISAOR MASTERCARD ONL
:Y)
NAME ON CREDIT CARD: _______________________________________________________________
CREDIT CARD NUMBER: __ __ __ __ - __ __ __ __ - __ __ __ __ -__ __ __ __
EXPIRATION DATE: ____/____
SIGNATURE: ___________________________________________________________________________
MAIL COMPLETED APPLICATION TO: NAMBA INTERNATIONAL
1815 HALLEY STREET
SAN DIEGO, CA 92154
CREDIT CARD APPLICATIONS CAN BE FAXED TO: (619) 424-8845