EAA Chapter 106 Membership Application
We are delighted that you are joining our great EAA chapter !
NOTE: Your EAA106 membership expiration date (always Dec.31) and your EAA membership expiration date (1 year from when you join EAA National) may be different.
NOTE: Only a few of the below questions are *REQUIRED* -- including:
. . . . . . 1) CONTACT INFO - e-mail, snailmail address, phone(s)
. . . . . . 2) EAA # & expiration date (EAA membership is REQUIRED to be a member of a chapter)
. . . . . . 3) Membership type (regular, family, or student)
. . . . . . 4) Method of payment (question is towards the end)
We HOPE you will provide the additional information in some of the optional questions, too.
DUES: To complete your membership, you will need to make your EAA106 DUES payment either on-line (preferred), in person (at a meeting or event), or a check via mail. Once your application has been received and if you have not already paid at a meeting or event, we will send you the correct amount to pay and either an invoice to pay by credit card or a snail-mail address for a check.
If interested in an EAA106 LIFETIME membership (only via check), please note that in the comments and MAIL a check (or bring it to a meeting). EAA106 Lifetime membership rate is $500.
NOTE: Our general E-MAILS are sent with member addresses in the BCC.
Please put the following e-mail addresses in your address book to avoid problems of your mail system not recognizing our mails as valid. You will receive mails mostly from:
REMEMBER to hit SUBMIT at the end of this form.
IF the form does not disappear ... you missed a required question, so please scroll up, look for red boxes & fix, then submit again.
IF the form does disappear -------- you should scroll up and see a message which says “Your response has been recorded”
Sign in to Google
to save your progress.
The following section contains the questions which REQUIRE an answer or else the form will not submit:
REQUIRED --- DATE of Application (xx/xx/xxxx)
REQUIRED --- Your FIRST NAME as you would like it displayed in the ROSTER (informal is perfectly ok)
NOTE: The ROSTER is only shared 3 places: 1) within our membership so members may make one-on-one contact about similar aviation interests 2) our headquarters and 3) the Lawrence Municipal Airport (since we're tenants and EAA106 members qualify to apply for an airport ID - as long as you maintain membership with BOTH EAA106 & EAA).
REQUIRED --- Your LAST NAME
REQUIRED --- E-MAIL ADDRESS
E-Mail is required for all memberships --- It is our ONLY method of communication of news and newsletters so that all of the DUES money may be applied to our programs (rather than paper & postage)
REQUIRED --- US postal mailing address -- address, city, state, zip
While we typically use e-mail for communications, there may be an occasional exception, so we also need your "snail-mail" address
REQUIRED --- Phone - Home
If you use your cell as your home phone, enter the word CELL, then enter your cell phone in the next field below.
OPTIONAL --- Phone - Cell
OPTIONAL --- Phone - Work
Only provide if you wish to share - for being contacted if you cannot be reached via home or cell first.
REQUIRED --- MEMBER of EAA (Experimental Aircraft Association) status -- If not yet, this is a REQUIREMENT by EAA of all chapter members and you may join within a few days of submitting this application (we suggest joining by calling 1-800-JOIN-EAA - and ask for your EAA # on the call).
You may join both EAA106 and EAA concurrently, so call 1-800-JOIN-EAA to join EAA (they are open Mon-Sat). Be sure to tell them you are joining EAA because you have joined EAA106 and ask them to give you your EAA # & EAA expiration date right then - then e-mail us that info to
YES, I'm already a member of EAA and know my EAA membership is current
YES, I just joined EAA -- BUT I'm waiting for my card in the mail, so I don't yet know my EAA # - I'll e-mail it as soon as I have it.
NOT YET - I know I must join EAA, but EAA is closed right now so I will call EAA to join as soon as they are open
REQUIRED --- If you have your EAA NUMBER, please enter it here: If you are calling EAA right now to join, please ask them to assign your EAA NUMBER while on the phone (1-800-JOIN-EAA). If you joined EAA but didn't get your EAA# yet, please WRITE "JUST JOINED EAA" then E-MAIL your EAA # to
as soon as your receive your membership card from EAA! IF you have not yet joined and EAA is closed today, write "WILL CALL EAA TO JOIN" this coming week.
REQUIRED --- HOW will you be paying you chapter member DUES and New Member Fee?
NOTE: The dues will be prorated for the remaining calendar year, by quarter - $5/qtr for single person, $6/qtr for family). The new member fee will be waived if you e-mail a picture of a LWM airport badge to
(or agree to get one right away (1-2 weeks) and submit that photo of the badge to the Treasurer).
I plan to pay via CREDIT CARD (preferred & fastest method) - E-mail me an on-line payable invoice for the amount I owe.
I will mail a CHECK to the Treasurer - Send me an e-mail with the amount and address.
I will bring a CHECK or CASH to the next meeting (if in the next couple of weeks) - Send me an e-mail with how much I owe.
I have already paid -- at a recent meeting or event -- and am just completing my membership application process on-line.
REQUIRED --- TYPE of EAA Chapter 106 MEMBERSHIP (This membership is separate of the required membership with EAA - and expiration dates will likely be different)
Regular EAA106 Membership -- One adult (age 18+ -- You must be (or become) a member of EAA)
Family EAA106 Membership -- 2 or more members living in the same household (Husband/Wife, Parent/Child, Partners, etc -- ALL must be (or become) members of EAA)
Youth EAA106 Membership (free, but MUST have EAA membership which is free after Young Eagles flight) -- ages 8-19 -- You must include your PARENTS information (name & contact) in the last Comments field on the form !
LIFETIME EAA106 MEMBERSHIP -- (Payment via check, NOT PayPal) -- (You must be (or become) a member of EAA)
REQUIRED: (if not applicable, just enter N/A) -- IF you are joining as a FAMILY membership, please give us NAME, EAA #, & EAA EXPIRATION DATE info for each of the additional members. Please include age for any member who is age 21 or less.
Please enter each NAME (plus their EAA #).
While the following are OPTIONAL questions, we hope that you will take a minute or two to give us more info to better serve you and know if you can help the chapter someday, too.
OPTIONAL --- AIRCRAFT - If you OWN (or RENT) a certified aircraft (or fly a purchased homebuilt aircraft), enter make/model here - as well as based airport ID
Indicate if own or rent if a certified aircraft.
OPTIONAL --- AIRCRAFT - If you BUILT a homebuilt aircraft, enter make/model here - as well as current status (flying & based airport ID, upgrading, sold, etc)
OPTIONAL --- AIRCRAFT - If you are BUILDING a homebuilt aircraft, enter make/model here - as well as status (x% complete, expect to complete by xx/xx, project on hold, etc)
OPTIONAL --- AIRCRAFT - If you have an interest (even mild) in someday BUILDING or BUYING an aircraft, enter make/model - as well as degree of interest (ready to start in next few months, someday my dream, etc)
If interested in a possibly co-ownership of a certified aircraft or are interesting in building an aircraft with other members, tell us that, too.
OPTIONAL --- PILOT -- RATINGS (if any), Student, desire to start flight training, or enter ENTHUSIAST (if no pilot ratings or interest) - about 1/3 of our members are aviation enthusiasts!
Note: EAA106 chapter members receive a discount at one flight school if they are new clients - ask for info on the 5% off and 10% details
OPTIONAL --- TECHNICAL HELP -- A&P, AI, EAA Technical Counselor, EAA Flight Advisor, AME, CFI, CFII, or other technical expertise
Enter info you are willing to share. If you are willing to help members with their aircraft or flying (example: one of our members gives free BFRs to members), let us know and be sure to indicate whether that help is for a fee or free (latter is great if you don't want to build an entire aircraft, but would like to help with some with a homebuilt under construction. If you just want to tell the leadership, but not all of the membership, send the specifics in an e-mail.
OPTIONAL --- AVIATION SPEAKERS -- If you are willing to be a speaker (or workshop instructor) enter info here about your aviation topic. If you know of any good speakers, share that info here.
OPTIONAL --- VOLUNTEER - YOUNG EAGLES -- Are you willing to fly youth (ages 8-17) as part of the EAA Young Eagles program? The program has flown over 2 million youth! Or help as ground crew?
We hope you will be willing to help inspire these future pilots & aviation enthusiasts! NOTE: EAA provides additional insurance for your Young Eagle flights. To learn more go to:
the click on Pilot Guidelines
YES - I own a certified plane and am willing to fly Young Eagles
YES - I own an experimental plane and am willing to fly Young Eagles
YES - I rent a plane and am willing to fly Young Eagles
I'm a pilot but would prefer to help as ground crew at YE events
I'm not a pilot but am willing to help as ground crew at YE events
OPTIONAL --- VOLUNTEER to FLY other members We have MANY members who are building aircraft, but they have none in which to fly (their money is tied up in their project), so help inspire them to work on their project by giving them a ride! We also have members who have lost their medicals and would probably love a flight! And many members who are either student pilots (some of whom ran out of funds) or aviation enthusiasts whose aviation dreams may be rekindled by a flight!
There is no formal program for this, so this is different than the Young Eagle flights. Ideally, offer at a meeting to take someone up after the meeting or make an offer when you see an announced "Dawn Patrol" (monthly fly-drive aviation destination).
I'm willing to fly other EAA106 Members in my certified aircraft
I'm willing to fly other EAA106 Members in my homebuilt aircraft
I'm willing to fly other EAA106 Members in my rented aircraft
OPTIONAL --- INTERESTS -- We need input to help develop programs (seminars, workshops, & events)
PLEASE CHECK ALL WHICH APPLY
I'm interested in homebuilt aircraft programs - speakers, visit projects, etc
I'm interested in hands-on workshops about aircraft building techniques (note: there may be a fee for materials & outside speaker)
I'm interested in Fly-ins - to see some homebuilt aircraft
I'm interested in programs about aviation safety - flying, medical, survival, aircraft maintenance, etc
I'm interested in aviation history programs
I'm interested in the EAA museum aircraft tours (EAA106 hosts the B-17 & the 1929 Tri-Motor - volunteers needed! - see above)
I've been to AirVenture in Oshkosh, WI - and would like to go there again
I have not yet been to AirVenture (end July) but would like to (see
I've been to Sun-N-Fun in Lakeland, FL - and would like to go there again
I have not yet been to Sun-N-Fun (in April) but would like to (see
OPTIONAL --- Do you belong to any other EAA chapters and if so, which ones?
Examples: VIN-15, EAA196, UL-62, etc - You may belong to more than one chapter - several if you wish (paying dues to each chapter).
OPTIONAL, but we hope you'll fill out --- LAST QUESTION: HOW DID YOU LEARN ABOUT EAA CHAPTER 106 ?
Please check **ALL** which apply
From a member of EAA106
Attended an EAA106 event - B-17, Tri-Motor, Fly-In, or LSA Expo
Attended an EAA106 workshop, program, or meeting
Saw an EAA106-produced ad or program on TV
Saw a story about EAA106 in the newspaper, TV, or radio
From the IMC Club / VMC Club Program
OPTIONAL --- If you have any short COMMENTS, please enter them here. If long, please send a mail to: EAA106.President (- at - GMAIL.com)
THANKS for your SUPPORT !! WELCOME TO EAA106 !!
NOTE: Once your application has been received and if you have not already paid at a meeting or event, we will notify you of the correct amount to pay (new member fee, unless badge +plus+ prorated (partial year) chapter dues). We will send either an invoice to pay by credit card or a snail-mail address for a check as you indicated in an above question.
Be sure to hit SUBMIT below. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - NOTE: If the form is still on the screen after you hit submit, scroll up, look for the red boxed section(s) for incomplete REQUIRED (*) question(s), FIX, SUBMIT again.
THANKS FOR JOINING & SUPPORTING EAA CHAPTER 106 !!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service