TO:	Secretary, NZMAA, Paul Lagan
	1183 Blythe Road, RD3 CHEVIOT 8271
		
WINGS BADGE and/or TYPE CERTIFICATE ORDER FORM

CLUB NAME:		
(As you want it to appear on badge)
ADDRESS TO SEND ORDER TO:		
		
		
	
CONTACT NAME:			PHONE NO:		/	

"The following financial members of our club have passed the NZMAA RC Flight Proficiency Programme and have been certified as being proficient by an approved club examiner."

 (Signed)……………………………………..(Date)……………………………..


MEMBER
CODE	
MEMBER'S NAME  (Print)
	Badge Required?
Yes/No	CROSS if you don't want Club name on the badge	
MODEL TYPE(S) 
( 'S' 'A' 'F'
'M' 'L' or  'H')	
					
					
					
					
					
					
					
					
					
					
					
					
					

NUMBER OF WINGS BADGES REQUIRED		   x  $10.50   =  	$	

PAYMENT MUST ACCOMPANY ORDER			OFFICE USE ONLY		
(Note: No charge for Certificates)			RECD:			
Please allow approximately 14 days for badge orders to be completed .			DATE SENT:			
.			PAYMENT RECD:	$