150th Aero Flying Club

Application For Membership
Name:
 DOB:
 Email Address:
Home Address:
 City, State, Zip:
Home Phone:
 Business Phone:
Employer:
 Occupation:
FAA Certificate No.:
 Ratings:
Medical(Class & Date):
 Medical(Restrictions):
Pilot Experience(Hrs):
Total:
 Night:
 IFR:
 Retractable:

Aircraft Types & Approximate Hours:

Biennial Flight Review:
Date:
 Aircraft:
 Reviewer:

Names & Addresses of Clubs/FBOs whose aircraft you have flown:

Types of Flying? (VFR, IFR, business, pleasure, long trips, hours/year?)

Flying Plans/Objectives?

How did you hear of the 150th Aero Flying Club?

The following two questions must be answered! Explain if the answer to either is "Yes ". Answers will be kept strictly confidential.

Have you ever been involved in an aircraft accident?:

Explanation:

Has the FAA ever taken any action against you?:

Explanation:

By submitting this Application for Membership to the 150th Aero Flying Club, hereafter referred to as the Club, you are certifying that the above information is accurate and complete and, if offered membership in the Club, you further agree that:
(a)you will pay a non-refundable initiation fee of $248 and you will purchase an equal share in
the Club for $1500, which is refundable upon resignation;
(b)you will pay monthly dues, hourly flying charges, and any special assessments authorized by the membership or the Board of Directors;
(c)you will be guided by and obey the Constitution, By-Laws, and Operating Instructions of the Club.


Date Submitted:

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