Falcon Flying Club, Inc. Membership Application

Falcon Flying Club, Inc.

Membership Application

Type of Application:                                 r Owner Member                                 r Social Member

General Information

Name:

Date of Birth:

Social Security Number:

Street:

Apt#:

City:

State:

Zip:

Phone:

E-Mail Address

Marriage Status: r Married r Single r Separated / Divorced

If Married, Spouse's Name:

Nearest Relative:

Address:

Employer Information

Employer:

Address:

Phone:

Supervisor:

Pilot Information

Flying Hours:

Certificate #:

BFR Due:

Medical Due:

Certificates:

Ratings:

Class of Medical:

r1^st   r2^nd   r3^rd

Credit References (see attached credit check authorization form)[1]

Institution

Type of Account

Phone# and Point of Contact

Falcon Flying Club References                                               Business References

1.

1.

2.

2.

3.

3.

Declaration: I (please print your name)____________________________________________warrant the truth and accuracy of the for going information and agree to abide by the constitution, by-laws, FAR's, and operational rules of Mentone Flying Club, Inc.

Signature:

Date:

Applicant Approved By (For Office Use Only)

BOD 1:

BOD 2:

BOD 3:

Owner Certificate #:

Date Issued:

FFC-Form NFP (12-2003)