individual membership

							    CENTRAL FLORIDA HELICOPTER ASSOCIATION




                                   Individual
                              Membership Application
                              Date:________________________


Name: ________________________________________________________________________

Address:______________________________________________________________________

______________________________________________________________________________

Home:_________________________________ Cell:___________________________________

Work:__________________________________ Wk Fax:_______________________________

E-mail:________________________________________________________________________
                                         Print legibly

                                    Circle all that apply:

Pilot   Student     Instructor     Mechanic         Admin             Support Personnel

ENG EMS             Charter        Public Safety             School         Military

Other ________________________________________________________________


Individual membership dues:        $15 annually              Date Paid:_______________


Treasurer signature _________________________________

                   Mail checks to: Central Florida Helicopter Association
                                          Mail to:

                                         CHFA
                                    P.O. Box 149663
                                 Orlando, Fl 32714-9663