Schaumburg Pilots Association

Membership Application

NEW ___ RENEWAL ___ Address Change ___Yes



NAME _________________________________________________________________

ADDRESS ______________________________________________________________

CITY, STATE ZIP _________________________________________________________

Month of Birth ____________Phone _____________________
 
E-mail address _______________________

Aircraft owner? Yes ___ No ___ If yes, aircraft type _______________ N Number_______

Renter?  Yes ___ No ___ Student? Yes ___ No ___

Interested in helping club?   Yes ___

What topics would interest you at our monthly meetings?

__________________________________________________________________________

__________________________________________________________________________

What are your interests in aviation?

__________________________________________________________________________

__________________________________________________________________________

Thank you!

Dennis ercoupe564@yahoo.com

P.S. Please print this form and send along with a check or money order  for $25.00 made payable to; Schaumburg Pilot's Association, P.O. Box 72475, Roselle, Illinois 60172 or bring check or cash and this form to the next meeting.