Tripoli Amarillo #92 POTROCS Inc
A Non Profit Organization
16651 FM 1541 Canyon, Texas 79015
806-488-2756

             Club Officers
Pat Gordzelik President/Prefect
Steve Graham Vice-President
Lisa Palechek Treasurer
Howard Palechek Secretary
Barre' Wheatley Web Master

 

Membership Application
&
Launch Registration
Rocketry Lives in The Texas Panhandle

Submit questions using the Feedback link in the INFO section on the navigation menu.
If you prefer to mail the form please complete all fields except the signature field. Print the form, sign it and mail to the address in the upper left corner.

  

     

  
                        xxx-xxx-xxx

        
            mm/dd/yy

(If you don't know what level means choose level 0)

Membership:

All Memberships renew June 1st. New members who join after December 1 pay 1/2 the normal yearly membership fee.

Launch Fees:

I understand POTROCS and/or Tripoli Rocketry Association, Inc are not able to assume liability of any kind
with regard to my activities or the activities of others. I agree to pursue my rocketry activities in conformance
with the by-laws and saftey codes of POTROCS and the Tripoli Rocketry Association.

  
           yy/mm/dd                                  email - type name
                                                            fax - sign name



Credit Card Payment

Please fill out this form and submit it. By completing this form, you are granting permission to Potrocs, Inc, to process this charge for your membership through PGP to the credit card listed below.

        




Please expect confirmation for your application/registration. Your e-mail address is very IMPORTANT! 
Please print this form before you press the submit button.. Failure to do this could result in increased
launch fees at the launch site.

If you do not receive confirmation, it may mean that we did not receive your information or that we had problems
processing your information. If you do not receive confirmation please send an email to Treasurer. Please have the
subject line of the e-mail read POTROCS Application..