Please provide the following information:
Type of Ratings Held
Date of Last BFR
Date of Last Medical
Date of Last Flight
Hours to date
Hours last 12 months
next 12 months
Aircraft you are Qualified in
1. Have you been a member in another flying club?
If yes, which ones?
2. Have you ever been found in violation of the Federal Aviation Regs?
3. Has your license ever been suspended or revoked?
4. Have you ever had an aircraft accident?
(If yes, give details in Remarks Section)
5. I agree to take a check ride with the Club's Safety Officer or designee at my expense.
6. I agree to abide by all F.A.A. regulations and Club Bylaws and to keep the club posted on Medical Certificate expiration date and Flight Review date.
Coastal Fliers, Inc.
Revised: October 03, 2007