Application for Membership
Connecticut Tripoli Rocketry Association - 26
National Association of Rocketry, Connecticut - #522
(CTRA/NARCONN,Inc.)
New Member ______                                           Renewing Member ______                                           Info. Change ______
Name:_____________________________________________________________________Date:____/____/____
Street:______________________________________________________________________________________
City:________________________________________________________State:____________Zip:____________
Home Phone:_(_____)_____________________________Other Phone:_(_____)___________________________
E-Mail Address:________________________________________________@_____________________________
Date of Birth:____/____/____                                                      Occupation:___________________________________
Tripoli Number:__________________                                      NAR Number: :__________________
Certified High Power?_____     Tripoli - Level 1___2___3___     NAR - Level 1___2___3___    LEUP Holder? Y___N___
(Membership in National Organization is required to fly a motor larger than a "G")
Rocketry Interests:____________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Rocketry Experience:___________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___Single Senior Membership (Over 18)	$15.00 ______
___Single Junior Membership (Non-Voting, Under 18)	$10.00 ______
___Family Members (2.00 each)	$          ______
	Total: ______
Make Checks Payable to: CT Tripoli/NARCONN,Inc.	($20.00 Family cap where applicable)
Listing of Family Members
Name:____________________________________________	Date of Birth:____/____/____
Name:____________________________________________	Date of Birth:____/____/____
Name:____________________________________________	Date of Birth:____/____/____
Name:____________________________________________	Date of Birth:____/____/____
Mail Completed Applications to:	Blair A. Dupont
	560 Burlington Avenue
	Bristol, C.T. 06010-3107
	Tel: (860) 583-1690