Name:
___________________________________________________ SSN or Pilot Cert
#: _____________________
Date
of birth: ________________________ Driver's License #:_________________________
State:______________
Address:____________________________________
Phone:(H)_____________________ (Other)#______________
____________________________________ How
long? ________ Email______________________________
Former
address (if less than 3 years at current address) How long? ____________
_________________________________________________________________________________________
Employer:______________________________________
Phone:______________________
Address:_______________________________________ How long?___________________
________________________________________
FAA
medical class and
date:_________________________________________________________________________
Ratings:__________________________________________________________________________________________
Date of
last biennial flight
review:____________________________
Total Hours, PIC:__________
Hours last 6 months:__________
Have you ever been involved in
an aviation accident, incident or an event
involving an insurance claim?______________
(If yes, give details on
back.)
I
agree to abide by the Bylaws and Flying
Rules of Monterey Flyers, Inc., and any Standard Operating Procedures
established
by the Board of Directors. I also agree to pay the
established fees in a timely manner. I understand that the current fees
are:
Initiation Fee: $50.00
Monthly
Dues: $65.00
Late
Fee: $10% of outstanding balance starting next billing period.
Signature:
__________________________________________________________Date:_________________________
Action:
Date
application received:________________________________________ by:_____________________________
Comments:
Recommendation:
Signed:___________________________________________________________,
Chief Pilot
Board
Action:___________________________________________________ Date:____________________
Signed:
___________________________________________, President