First Name of Primary Member *

Last Name of Primary Member *

Physical Address of Residence *

Preferred Mailing Address (if different from physical address)

Home Phone (landline)

Personal Cell Phone

Business Phone

First Name of Associate Member (must reside at same physical address as primary member)

Last Name of Associate Member (must reside at same physical address as primary member)

Associate Member email address

Associate Member cell phone

Emergency Contact Information other than Associate Member (name, relationship, address, phone number and email)

Aviation Background *

Aircraft Ownership (Tail number, make, model, year, where based).

Own or Rent Aircraft? *