EAA Chapter 21 Application

EAA Chapter 21

Membership Application

Print this page with your browser (set margins to .75" or smaller, portrait orientation), fill it out, and mail it in with your dues or return to any EAA Chapter 21 board member.

Note: Chapter 21 membership does not include membership in National EAA. Dues for National EAA are $40/year for individuals, $50/year for families which includes 12 months of Sport Aviation. For more info, visit the National EAA Web Site at http://www.eaa.org/

Name:

^{_______________________________}

EAA#

^{________________}

Address1:

^{_______________________________}

Spouse's Name:

^{________________}

Address2:

^{_______________________________}

City:

^{_______________________________}

State:

^{_______________________________}

Zip:

^{_______________________________}

E-mail:

^{_______________________________}

Home Phone:

^{_______________________________}

Work Phone:

^{_______________________________}

I would like to receive the chapter newsletter (check one) Online_______ or by Mail_______

Aircraft Owned:_______________________________________________________

Aircraft Projects:______________________________________________________

Occupation:__________________________________________________________

How did you find out about Chapter 21?:_____________________________________

Additional comments may be written on the back.

Dues are $15 per year, payable in January. Please make check payable to: "EAA Chapter 21"
Please return this form with your dues payment to any EAA Chapter 21 Officer or snail-mail to:
EAA Chapter 21
c/o Steve Eberhart
P.O. Box 9227
Evansville, IN 47724

Name:	^{_______________________________}	EAA#	^{________________}
Address1:	^{_______________________________}	Spouse's Name:	^{________________}
Address2:	^{_______________________________}
City:	^{_______________________________}
State:	^{_______________________________}
Zip:	^{_______________________________}
E-mail:	^{_______________________________}
Home Phone:	^{_______________________________}
Work Phone:	^{_______________________________}