
Name_____________________________________________________________
Address___________________________________________________________
City_______________ State________________ Zip____________
Date of Application_________________ Phone (H) _________________
E Mail Address ___________________________________
If Renewal, Membership #________________________ (W)________________
Plese Check one:
___ $30.00/year - Regular Member
___ $25.00/year - Associate Member
Please note any additional information such as: special knowledge and skills, pilot experience, sales and promotional experience, etc.