NORTH COUNTRY MODEL CONTROLLERS
NEW MEMBERSHIP & RENEWAL FORM
Required Fields *
Your Name:
*
Home Address:
*
Phone Number:
*
Email Address:
*
AMA #
PLEASE SELECT MEMBERSHIP
 PAYMENT METHOD
Check
Junior Membership
 1YR $25.00
Money order
Adult Membership
 1st YR $50.00
Adult 1st yr introductory--Free embroidered cap
Family Membership
 1YR $60.00
Junior Renewal
 1YR $25.00
1YR $50.00
Adult Renewal
1YR $60.00
Family Renewal
MAKE CHECKS & MONEY ORDERS PAYABLE TO:
North Country Model Controllers
PLEASE SEND CHECKS & MONEY ORDERS TO:
TOM SKIME, 22839 500th St., BEMIDJI MN, 56601
CONFIRMATION OF PAYMENT WILL BE SENT:
VIA, E-MAIL OR POSTAL MAIL
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