app

							                                         Olds Forge Flyers, Inc.
                                                Membership Coordinator
                                                          PO Box 80565
                                                        Lansing, MI 48908

                                        MEMBERSHIP APPLICATION

Name__________________________________________Birth Date_______________
Home Address_________________________________Home Phone_______________
City_____________________State______Zip__________Cell Phone_______________
Email______________________________Email2______________________________
Business________________________________________Bus Phone______________
Driver License #_________________________________________________________

FAA Certificate #_______________Medical Cert. Date____________Class__________
Ratings________________________________Date of Last BFR__________________
Flight Hours: Total________PIC________Dual________SEL______MEL___________
C-172__________PA-28__________Complex___________High Perf_______________
Last 12 Months___________Last 6 Months____________Last 90 Days______________


Any aircraft accidents, FAA violations or suspensions? NO_________YES_________
Any automobile accidents, violations or suspensions?                            NO_________YES_________
                               (If yes to above questions, explain details on back of application)

Credit References:
1______________________ 2______________________ 3______________________
Skills of benefit to the club:_________________________________________________
Are you willing to assist in club operations? ___________________________________
I first learned about Olds Forge flyers from:
Internet Search_____Club Website______Landings.com______Mailing______Word of Mouth_____AOPA_______
Club Member____Name:_________________________FAA Safety Seminar____Other______________________

I hereby state the above to be true, authorize a credit/background check, and agree to
abide by the Constitution, Bylaws, rules and regulations of the Olds Forge Flyers, Inc.

Signature:_________________________________________Date:______________________
    (Entrance costs: $950.00 initiation fee, $65.00 first month dues, $100 Insurance Deductible Waiver, $10.00 key deposit.
      Total $1125.00. Subject to club membership committee interview and club board approval. Mail to above address.)
Board Action: Approved_____Rejected_____Conditions_______________________________________________
Date____________________
90357a08-3034-4ea9-8a69-c014a589bb8e.doc, Revised 11/20/2011