Membership Form

This membership form will be used to update the SRCHA Membership Database. We then use this information for tracking membership dues and newsletter/event mailings.

AMA Number: [Required] ________________________________ Date: ____________________________________

Name: [Required] _______________________________________________________________________________ 

Address: [Required] ______________________________________________________________________________

City/State/Zip: [Required] _________________________________________________________________________

Mailing Address:  ___ Same as Above    ___ Other _____________________________________________________

Phone: Home: [Required]___________________________ Work: [Optional] _________________________________

Internet Mail Address: ____________________________________________________________________________

Radio Frequencies Used: [Required]_________________________________________________________________

Types of Membership:   _____ Single Membership     ______ Family Membership

Note: There is a $25.00 one-time initiation fee for new members

For a Family Membership please include the name of the other family members and their AMA membership numbers below:

Name: _______________________________________________________AMA #: ___________________________

Name: _______________________________________________________AMA #: ___________________________

Please send check or money order to: SRCHA Membership

Brian Holst

2101 E. Cochise Avenue

Apache Junction

Single Membership...……($25.00)……………………………………………………………….= ______________________

Family Membership……..($50.00)………………………………………………………………. = _____________________

Initiation Fee …………….($25.00)………………………………………………………………..= _______$25.00_________

                                                                                                                                     Total =_____________________

 In Case of Emergency Please Notify:

Name: ________________________________________________________Relationship______________________

Address:_______________________________________________________________________________________

City/State/Zip: __________________________________________________________________________________

Phone: Home: _____________________________________ Work: _______________________________________