Last Name: ___________________First
Name:_____________
If married, Wife's Name:____________
If any, Children's Names:_________________________________
Street Address:________________________________________
City:______________________ State:_______ Zip: _____-____
Home Phone: __________ Work Phone:__________________
Email Address:_______________________________________
(For mail-outs to you
and members ONLY!
Not shared with anyone
else!)
EAA Number: __________________________Expires:
_______
(Not a requirement to
be a Chapter 541 member, but advisable.
Must be a National member to be an Officer or Board Member or to participate as a pilot in the Young Eagles
program.)
If you own an aircraft,
which type?: ______________________
N Number:________________
Building an aircraft,
which type?:________________________
Give
us a little background on you and your family.
What aircraft, projects, or aviation interests do you have?
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