WESTERN FLYING CLUB
Application for Membership
Name
First Name
Last Name
Email
example@example.com
Date of birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (cell)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (work)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (home)
Please enter a valid phone number.
Format: (000) 000-0000.
Employer
Employed since
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employer address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Flying experience
Ratings and certificates
Ratings/Medical
Student
Private
Commercial
ATP
Instrument
Complex
High performance
Other
Date of last flight review
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of last medical
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Medical class
Type of Aircraft Flown and Hours in Each
Rows
Type
Hours logged
Date last flown
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Location of flying experience for the past two years.
Name of instructor (if student)
Instructor phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you had any automobile traffic violations in the past two years?
Yes
No
Have you ever been convicted of a DUI?
Yes
No
Have you ever been involved in an airplane accident or incident?
Yes
No
If yes to any of the above, provide complete details
Why do you desire to join the Western Flying Club
I understand that false statements on this application shall be considered sufficient cause for dismissal. I have read and agree to abide by the By-Laws and operating rules of the Western Flying Club.
*
Submit
Should be Empty: