Membership Application

Your Name (required)

Street address (required)

City, State, Zip (required)

Work Telephone

Home Telephone

Cell phone

Your Email (required)

Second Email

Hours Flown (total time, last 12 mo.)

AIRCRAFT
Type Most Flown

RentedOwnedPartnerUse of
N number (if applicable)

RATINGS (check all that apply)
Non-pilotStudentSport PilotRecreationalPrivateCommercialATPASELAMELASESAMESGliderUltralightHelicopter
Instrument Rating YesNo
Flight Instructor CFICFIICFI-MECFI-Glider

TYPES OF ACTIVITIES DESIRED (check all that apply)
Poker RunSpot-Landing ContestTechnical PresentationFly-in BreakfastFly-in PicnicAir RallyMuseum TripsCamping

Please provide any suggested destinations, other types of activities, or any other comments: