2003 EAA CHAPTER 407 MEMBERSHIP APPLICATION
(Please complete as much as you can as the information will go into this years chapter roster)
NAME_____________________________________________NATIONAL EAA NUMBER__________ SPOUSES OR SIGNIFICANT OTHERS NAME_____________________EAA NUMBER______________ STREET__________________________________________YEAR JOINED NATIONAL____________ CITY/STATE/ZIP____________________________________YEAR JOINED CHAPTER____________ HOME PHONE________________________________ WORK PHONE__________________________ E-MAIL ADDRESS___________________________________________(PLEASE!) ARE YOU A (X if applicable) CFI____ A&P____ AI____ Pilot_____ INTERESTED IN HOLDING A CHAPTER OFFICE? YES____ NO____ |
AIRPLANE INFORMATION
Make/Model |
Category |
Year |
Status |
Based At |
(Cessna/T18) |
(Standard/Exp) |
(1995) |
(Flying/Building) |
(Airport) |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
__________ |
COMMENTS/SUGGESTIONS FOR IMPROVEMENT/PROGRAM IDEAS/WHAT YOU THINK WE COULD DO BETTER OR DIFFERENTLY TO ENHANCE THE CHAPTER ______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ ______________________________________________________________________________________ |
| PLEASE MAIL COMPLETED APPLICATION AND A CHECK FOR $24 (New members $28 total to cover name tags) TO EAA CHAPTER 407, RT 1 BOX 85A., Pocatello, ID 83202-9703 or give money to our treasurer when you see him. |