ARIZONA BLUE SKY FLYERS MEMBERSHIP APPLICATION

FILL IN ALL APPLICABLE BLANK FIELDS

Member Name: ____________________________________________________________________

Spouse Name: _____________________________ Home Phone: ___________________________

Street Address: ____________________________________________________________________

City State ZIP: ____________________________________________________________________

E-Mail Address: ___________________________________

Business Phone: __________________________ Company: _______________________________

CHECK PILOT CERTIFICATE GRADE AND ENTER RATINGS HELD:

_____Non-Pilot _____ Ultralight _____ Student _____ Recreational

_____ Private _____ Commercial _____ ATP ______ Instrument

INDICATE INSTRUCTOR CERTIFICATES AND RATINGS HELD:

Flight Instructor Ratings: ____________________________________________________________

Ground Instructor Ratings: ___________________________________________________________

OTHER PILOT INFORMATION:

Total Pilot Hours: ___________ Hours Last 12 Months: ___________

BFR Date: ____________________ Medical Date: ___________________

Own a Plane? Type: ______________________ N=Number: ______________

RATE THESE MEMBER BENEFITS ON A SCALE OF 1-10 (10 = Very Important):

____ Aircraft Rental Discounts ____ Informative Speakers

____ Merchandise Discounts ____ Overnight Fly-Ins

____ Club Simulator Use ____ One-Day Fly-Ins

____ Club Equipment Loans ____ Social Activities

____ Ground School

MEMBERSHIP, DUES, AND FEES:

ABSF membership is for a calendar year. Annual dues of $25.00 are due January 1 each year (additional family members at the same address $10.00 - BOTH require applications and waivers). New members prorate dues for remainder of the year and include $20.00 initiation fee.

Select: New Member Dues ($25) plus $20 initiation fee =($45) $_______, Renewal $25. _______, or Family Member $10_______. If you would like a key to the Equipment Cabinet, please check here ___ and include a $3.00 annual fee with your dues.

BE SURE YOU READ AND SIGN THE WAIVER ON THE BACK OF THIS APPLICATION.

MAKE CHECK PAYABLE TO `ARIZONA BLUE SKY FLYERS and MAIL WITH APPLICATION TO:

Tanna Romberg, ABSF Treasurer

6376 W Donald Drive

Glendale AZ 85310