Aero Fliers Membership Application Form

Aero Fliers, Inc.

Application for Membership
Due to insurance constraints, we are no longer able to accept student pilots.
Personal Information:
Full Name*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
E-mail*
Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
Work Position
Years Employed*
Have you had any vehicle/aircraft accidents or convictions in the last 5 years?*

YesNo
If yes, please explain
Reasons for wanting to join Aero Fliers*
How did you learn about Aero Fliers*
Flying Experience

Membership at Aero Fliers requires at minimum a private pilot's license
Total Hours:*
Dual Hours:*
Ratings:*
Certificate Number:*
Last Flight Review*

MonthDayYear
Last Medical*

MonthDayYear
Type of Medical

3rd class2nd class1st classBasic Med
Personal References
Reference #1*

Name

Street Address

CityState

Zip Code
e-mail address
Area CodePhone Number
Reference #2*

Name

Street Address

CityState / Province

Postal / Zip Code
e-mail address
Area CodePhone Number
I have read the Code of Regulations and the Operating rules of Aero fliers, Inc, and if admitted as a member, I agree to abide by them. I acknowledge that if my membership or emloyment should be terminated, or if my account becomes over sixty days overdue, Aero fliers Inc. will have every right to take any legal steps available, including the right to have my employer deduct the unpaid balance from my salary.
Required*

YesNo
Date

MonthDayYear
Date
Either send the form electronically or mail to:

Aero fliers, Inc., P.O. Box 2213, Akron, OH 44309
Should be Empty:

Aero Fliers, Inc.

Personal Information:

Flying Experience

Personal References