Lamoine
ME 04605
APPLICATION FOR MEMBERSHIP
Please print out this form, enter the following information and mail
the completed form, a check for $300.00, and a copy of your medical and license
to the above address.
By your signature you signify that you have read the club bylaws and
agree to abide by the rules and regulations of the FBFC.
Date:
Name:
Mailing Address:
State:
ZIP:
E-
Home Telephone:
Business Telephone:
Date of Medical:________ Date of Biannual
Review:______
Ratings: Student:__Recreational:__Private:__Commerical:__
Instrument:__
Reference (member or flight instructor):
Address: Phone:
If share was purchased from a member of the club please list name:
Signature: