Syracuse Flying Club Membership Application
Thank you for your interest in joining the Syracuse Flying Club!

Please complete and submit this form to the membership chairman by clicking the submit button below. You may also print/mail it c/o Tom Forleo, Membership Chairman, 6508 Electric Railway, Cicero, NY 13030

In addition to this form, please submit a copy of your pilot certificate(s) and medical certificate, as applicable.
First Name *
Last Name *
Email *
Phone *
Alternate Phone
Residence Address *
City, State *
Zip code *
Date of Birth *
Pilot certificate number
Photo ID number and type (such as driver license or passport) *
Total PIC hours
Previous 12 months PIC
Most recent flight review date
Have you ever had a reportable accident as pilot in command?
Clear selection
Have you ever been convicted of a felony? *
Have you ever been arrested for any alcohol or drug related offenses in any powered vehicle, aircraft or vessel? *
Have you ever been cited for any violations of FAA regulations?
Clear selection
Have you ever had an insurance policy cancelled (medical, aviation, automobile)? *
Have you been involved in any automobile or vessel accidents in the past 36 months? *
If you have answered YES to any of the above, please explain the circumstances.
Your responses will be held in confidence by the officers of the Syracuse Flying Club, unless otherwise required by law.
Employer
Bank where you hold checking/savings account(s) *
Required as you are being granted credit by the Syracuse Flying Club, as you are billed monthly following aircraft use
In which areas are you most interested in using Syracuse Flying Club aircraft?
Please check all fields that apply
I have reviewed the bylaws and the standard operating procedures of the Syracuse Flying Club, Inc. I shall read, understand and abide by all existing bylaws and procedures, and any that may be enacted in the future. I authorize the Syracuse Flying Club to investigate claims made above as necessary. I agree that any and all expenses incurred by the Syracuse Flying Club Inc. to collect a debt incurred by me shall be included in the settlement amount. I certify that the information given above is true and accurate to the best of my knowledge, and I understand the agreements and conditions of membership. *
Type your full name below as your required signature
I accept financial responsibility for this minor applicant
Required when applicant is under 18 years of age
Parental e-mail address if applicant under 18
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