Dayton Area Thermal Soarers Membership Application


NAME:_________________________________________________________________________


ADDRESS:______________________________________________________________________


______________________________________________________________________________
	

CITY:__________________________________ STATE:______ ZIP:_____________________


E-MAIL ADDRESS: ______________________________________________________________


PHONE:_______________________________ DATE OF BIRTH: _________________________


AMA #:_______________________________ LSF #:__________________________________


SPONSORING MEMBER:____________________________________________________________


FREQUENCY'S USED:_____________________________________________________________


FAMILY MEMBERS (If Family Membership Selected, AMA Membership required):


_____________________________________AMA #:____________________ DOB:__________


____________________________________ AMA #:____________________ DOB:__________


____________________________________ AMA #:____________________ DOB:__________

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YOU MUST SHOW PROOF OF AMA MEMBERSHIP TO THE PERSON ACCEPTING THIS APPLICATION
FOR MAIL IN APPLICATIONS, A PHOTOCOPY OF THE MEMBERSHIP CARD IS REQUIRED.
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FEES:                                               MAIL TO:

___________ One Time Initiation Fee..................$1		Dave Gerspacher
___________ Individual 1 Year Membership.....$25		205 Sheldon Drive
___________ Family 1 Year Membership.........$25		Centerville, OH 45459
___________ Newsletter Only..................$7     USA

$__________ AMOUNT ENCLOSED

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REMEMBER BEFORE SEALING THE ENVELOPE: 
1.  THE COMPLETED D.A.R.T.S. MEMBERSHIP FORM                                        
2.  A SIGNED CHECK MADE OUT TO "DARTS" FOR THE PROPER AMOUNT.  DON'T SEND CASH
3.  A PHOTOCOPY OF CURRENT AMA MEMBERSHIP CARD(s). DON'T SEND THE ORIGINAL
4.  PLEASE INDICATE IF YOU DO NOT WANT YOUR E-MAIL ADDRESS ON THE WEB SITE.