Application Date * MM DD YYYY Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Driver's License Number * Date of Birth * MM DD YYYY Married? * Yes No Citizenship * Former AAF Member * Yes No If Former AAF Member What Date MM DD YYYY Total Hours Pilot License Number * Medical Type * 1st Class 2nd Class 3rd Class Basic Med Expired Medical Date MM DD YYYY Limitations * Ratings * Date Began Flying * MM DD YYYY Date of Private License * MM DD YYYY Last Time Flown * MM DD YYYY Types of aircraft which you have been PIC * Where have you rented aircraft? * Flight Instructor (Include address) * Your special talents that could contribute or assist the AAF Operations * List other flying clubs, social or professional organizations in which you are or have been a member Personal Reference #1 (address, telephone & relationship) * Personal Reference #2 (address, telephone & relationship) * Credit Reference (include bank name) * Flight | Driving | Criminal Background * For any checkboxes marked, please use text field below to provide explanation and any further details. I've had an aircraft accident, incident, or a FAR violation I've been charged with violation of FAA regulations I've been convicted of a crime I've had a motor vehicle accident in past 3 years I've had a moving violation citation in the past 3 years I've been convicted for operating a motor vehicle while under the influence of alcohol or drugs Other None Explanation(s): Flight | Driving | Criminal Background Present Employer * Number of Years Employed * Job Description * Employers Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Previous Employer * Number of Years Employed (prior employer) * Job Description (prior employer) * Employers Address (prior employer) * Address 1 Address 2 City State/Province Zip/Postal Code Country Checkbox * I hereby certify that all information provided above is accurate and complete. By typing my full name on this application (below), I acknowledge that it serves as my digital signature. I affirm that I am not misrepresenting myself or any other individual. If accepted for membership, I agree to abide by the Operating Procedures and By-Laws of the Ann Arbor Flyers, Inc., and promptly pay all invoices. I understand that any falsification of this application is sufficient grounds for expulsion from the Ann Arbor Flyers, Inc. Please note that I may be required to sign a hard copy of this application if requested by the Ann Arbor Flyers, Inc. Digital Signature * Use your full legal name First Name Last Name Thank you for your application. We’ll review and be in contact with you at the email address or phone number provided.
