Membership Application Please print, fill out and mail it, with your  check payable to Tripoli Vegas and send it to: Tripoli Vegas Membership Larry Johnson 5711 Deer Valley Dr. Las Vegas, NV 89156   Or bring it to any Tripoli Vegas launch

Last name ____________________________________ First Name__________________________________MI_______

Street Address _________________________________________________________ Phone _______________________

City _____________________________________ State _____ Zip __________ Alt. Phone________________________

Birthdate: __________________________________

Are you currently a member of Tripoli ?    ____Yes,    ____No.       Cert.  level _____         TRA#__________________

Are you currently a member of NAR?        ____Yes,     ____No.       Cert.  level _____        NAR # _________________

What is your Email Address? __________________________________________________________________________

Would you like to  include your information in Tripoli Vegas database, accessible by all members? ____Yes,  ____No
(Note: database includes name, home phone, Email, Web site, TRA# and your certification level).

Our club’s existence, activities and services depend on the contribution of time of its members.

Read This Text Before Signing Below:

I, the undersigned, understand Tripoli Vegas. is not able to assume liability of any kind with regards to my activities
or the activities of others.   I agree to pursue my advanced rocketry  activities in conformance with the club’s bylaws
and safetycode, and that I will be an active member of the association to the best of my ability. I agree that if I attend
invitation launches sponsored by Tripoli Vegas I will participate in set up, tear down,or launch control and agree
that failure to participate may be grounds for membership termination in Tripoli Vegas as outlined in the club
bylaws. 

Applications Date:_____________________________ Membership ID: ______________________________________