Club Application - Cross Country Flying Club

Your Name

Your Email

Cell Number

Home Phone Number

Address

City

State

Country

Birth Year (E.G. 1982)

Occupation

What ratings do you hold?

Total Flight Hours

Total Pic Hours

Total Hours Last 90 Days

Total Hours Last Year

Last Biannual Flight Review Date

Medical Calss (1st, 2nd, 3rd) And Date Issued

Have you ever had an accident in an airplane or beed in violation of a federal aviation regulation in the past?

If YES please briefly explain when the incident occuered and how

Have you been a member of a previous flight club. If so please provide a reference

Have you read all the clubs policies and agree to these rules?