Chapter 1358 Membership Application / Renewal
To renew/apply for membership please complete all questions.
Date
*
-
Month
-
Day
Year
Date
NOTE: You must be a member of EAA National prior to becoming an EAA Chapter 1358 member.
Are you a member of EAA National?
*
Yes
No
EAA National Number
*
Name (As listed with EAA National)
*
First Name
Last Name
Nickname / Go By
Spouse
First Name
Gender
Male
Female
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Birthday
*
-
Month
-
Day
Year
Date
E-mail
*
Home Phone
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Business or Occupation
*
Chapter 1358 Roster Management Privacy Setting (May choose more than one)
*
Set all to "Public"
Set all to "Private"
Set Address to "Private"
Set E-mail to "Private"
Set Home Phone to "Private"
Set Cell Phone to "Private"
Do you have an FAA pilot's certificate?
*
Yes
No
Certificate Type
Student Pilot
Sport Pilot
Recreational Pilot
Private Pilot
Commercial Pilot
Instructor
Airline Transport Pilot
Additional Certification Ratings
Do you own an aircraft?
*
Yes
No
Aircraft Make & Model
Current or past aircraft projects?
Yes
No
Aircraft Project Description
Are you interested in participating in our Young Eagles program?
Yes
No
Young Eagles participation type
Pilot
Volunteer
Are you interested in participating in our Eagle Flight program?
Yes
No
Eagle Flight participation type
Pilot
Volunteer
Are you interested in participating in the IMC and/or VMC clubs?
IMC
VMC
Areas of Interests
Homebuilts
Classics
Warbirds
Ultralights
Aerobatic
General
Please use this area to express your thoughts and suggestions for club activities, your interest in holding office, chairing a committee or volunteering as needed:
Terms and Conditions
*
Payment Type
Free Student Membership (must be 18 years old or younger)
Cash/Check (Bring to next meeting)
Credit Card
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Chapter 1358 Annual Dues
$
26.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Please verify that you are human
*
Apply for Membership
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