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Membership Application

Application for new or renewal membership.
You may also use this form to send us a change of address to update our database.
Please submit the following information, then have your check or Money Order in US Funds payable to AMMA, sent to the following address:

Pat Otto, Treasurer AMMA
10300 US Hwy 98 N, #1386
Lakeland, FL 33809-1048
Phone: 863-858-2106

New Renewal Update

TYPE OF MEMBERSHIP RATE/Yr. (US FUNDS)
1) Individual Member $25 $
2) Second Member, Same Household $10 $
3) Member Club $25 $
TOTAL $

1) Individual Member:
Last Name, First Name, Middle Initial, Mr., Mrs., Ms., Miss
2) Second Member:
Last Name, First Name, Middle Initial, Mr., Mrs., Ms., Miss
3) Member Club:
Club Name, Contact, Position

Address:
City:
State or Province:
Country:
Zip/Postal:
E-Mail Address:
Home Phone:
Work Phone:

Movie Club Affiliation:
(if any) Club Name, Club Contact, Phone

Formats Used: Film: 16mm   Super-8   Regular 8mm   Other:
Video: VHS   VHS-C   S-VHS   S-VHS-C   8mm   Hi-8   Other:

Camcorder?
Editing?

Do you do Computer Editing?   Yes   No
System Used?