MEMBERSHIP APPLICATION

 Date of Application
Applicant Information
Last name First name Middle
Street City State Zip
Home phone Work phone Cell phone Fax phone
Date of birth              
Occupation
Emergency Information
Name of person to notify in case of emergency Phone
Street City State Zip

 

 

Pilot’s License

Have license?  Yeso  Noo

 Type Number Total time as PIC Date of last BFR

Aircraft Model

Approximate Hours

Date of Last Flight
     
Other relevant experience:
 

Mail completed application to: KAS /PO Box 848, Keyport, WA 98385 (Steve Charbonneau-Pres: 360-876-4215)

Initiation fee: $600.00, Monthly Dues: $72.00 --Join us on the first Wednesday of every month

7:30 PM Bremerton National Airport-Main terminal buillding

Medical Certificate

Have medical? Yeso Noo

 Class Date Number Examiner’s S/N
 
References
Personal Phone
KAS Member Phone
Flight Instructor Phone
Other Phone
Are you willing to serve as a club officer if appointed, elected or volunteer? Yes o No o
 
Applicant’s Signature Date
Office use only
Date of Board
 Option offered

Accepted: Yes o No oYes
Other action needed:
President’s Signature Date