Membership Application/Renewal Albuquerque Aerostat Ascension Association PO Box 91030, Albuquerque, NM 87199-1030 Payment must accompany application! Do It Online! REGULAR MEMBERSHIP: $30 Annual Dues. The dues year is January 1st through Dec 31. Scan the code! LIFETIME MEMBERSHIP: $500 per person (must update information each year, no charge) MID-YEAR NEW MEMBERSHIP: $15 Mid-year Dues. After June 30th. (No reduction for renewals.) FAMILY MEMBERSHIP: Each additional person is $5 per year. Must be the spouse, significant other or family member (16 or older) residing at the same address who wishes to become a member. JUNIOR MEMBERSHIP: (No Charge) Family member under age 16 of a current member residing at the same address. NOTE: If applicant is under 18 years of age, written permission from a parent or guardian is required. All Regular and Family member(s) have voting privileges. Junior member(s) do not have voting privileges. Members in good standing on the last day of February will receive election ballots to vote electronically for the March election. New application NEW Regular ($30) Renewal Regular ($30) Member ID: ________ Renewal NEW Lifetime ($500) Renewal Lifetime (NC) Renewal Honorary (NC) Primary Member Information Name: _______________________________ DOB: (MM/DD/YYYY) ___ /___/______ Email: __________________________ Address: _____________________________ City: ______________________ State: _________ Zip Code ______________ Phone: (Home) _______________________ (Cell) ___________________________ (Work) ____________________________ Please indicate name and date of birth for all Family members. Use back of sheet for more family members. Family Member Information ($5 each) Spouse/SO: ______________________________ DOB: (MM/DD/YYYY) ___ /___/______ Email: _______________________ Other Name: ______________________________ DOB: (MM/DD/YYYY) ___ /___/______ Email: ______________________ Please indicate name and date of birth for all Junior members. Use back of sheet for more junior members. Junior Member (under 16 years of age) (Free) Name: ___________________________ DOB: ___ /___/______ Name: _________________________ DOB: ___ /___/______ Name: ___________________________ DOB:___ /___/______ Name: _________________________ DOB: ___ /___/______ I would be interested in helping Are you? (check all that apply) I agree to allow my information to be published on the following committees: Pilot in an electronic roster, available to current Cloudbouncer Crew members and sponsors only. Community Relations Balloon Owner Yes Crew Development Other ____________ No Education Flying Events I would like to receive a hard copy of the Cloudbouncer newsletter mailed to me Membership for an additional $15 per year fee. Program Topics Yes Special Events No Video/Tech/Website Ways & Means Release: For and in consideration of the privilege of being permitted to avail myself of the activities of the Albuquerque Aerostat Ascension Association (AAAA), the undersigned does hereby waive, release, and discharge AAAA, its officers, agents and employees from all liability, claim or cause of action for damage, injury or loss to person or property which the undersigned might receive or sustain from any cause or for any reason during the activites of the AAAA irrespective of when, where, how, or from whatever cause such injury might be sustained. The release is intended to be absolute and entire and binding upon the undersigned, their executors, administrators, heirs, and assigns. AFFIRMATION: Furthermore, I will adhere to the by-laws and rules as set down by the membership and the Board of Directors. Signature ___________________________ Printed Name _____________________________ Date ____________ Revised 01/25/2023 aaaa cloudbouncer JANUARY 2023 21