Muncy Indoor Flyers

April 22, 2007 Fun Fly

Pre-Registration Form

Member ($10) ______ Non-Member ($15) ______

People that become a member during the event will receive a $5 discount on their dues. Regular membership is $25. With Non-Member registration, this will be reduced to $20.

Name: _________________________________________

Street Address: _________________________________________

City: ______________________ State: ____________

Zip: _________________________________________

Phone: Area Code: _______ Number: _______________

E-Mail: _________________________________________

TX Channels: _________________________________________

Please note that Channels 33 and 34 are believed to be unusable within the STN Sports Dome due to major interference issues.

AMA Number: _________________________________________

Return Application To: Ron Angle, 428 East Lamb Street, Bellefonte, PA 16823

Please make checks payable to Ron Angle.