EAA CHAPTER 620 MEMBERSHIP FORM
MEMBERS PLEASE UPDATE YOUR DATA... INDIVIDUALS WHO WANT TO JOIN MAY ENTER YOUR DATA..WHEN RENEWING YOUR MEMBERSHIP PLEASE SEND YOUR DUES ($20.00) TO:
EAA Chapter 620       6142 Paradise Point     Miami,   Fl.  33157       (Checks Only)

AAA

 



FIRST NAME: LAST NAME: MIDDLE NAME:
SPOUSE:       
ADDRESS:       CITY: STATE: ZIP CODE:
HOME PHONE: WORK PHONE: EXT:
CELL PHONE:   FAX:
E-MAIL: 2nd E-MAIL:

DUES INFO.  DUES PAID: DATE PAID: YEAR PAID FOR:
                       EAA MEMBER #: EXP. DATE:

AIRCRAFT OWNED: N-NUMBER:
2nd AIRCRAFT OWNED: N-NUMBER:
AIRCRAFT BUILDING: N-NUMBER:

RATINGS: ATP:  COMMERCIAL:    INSTRUMENT:   PRIVATE:
                  CFI:   CF II:   MULTI ENG:   SINGLE ENG:
                  HELICOPTER:   SPORT PILOT:   GLIDER RATING:

ACTIVITIES:    BUILD:    HELP BUILD:    ACTIVITIES:    YOUNG EAGLES:
                            INSTRUCT:     CHAPTER OFFICE:    RESTORATION:
                           ULTRA LIGHT:    MEDIA PR:    VOLUNTEER SUN-FUN:
                           OTHER: