Membership Application

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Print fill out and return to:

Thurman Grass, President
1105 N. Thayer Rd.
Lima, OH. 45801

Bluffton Sky Pirates, Inc.
Application for Membership

Name______________________________ email address _________________

Address ________________________________________________________

AOPA member? Yes___ No___ Cell Phone _________________

Home Phone ___________ Business Phone ___________ Fax _____________

(Applicant's Pilot Experience)

Type License: ________ License Number: _____________

Ratings: _______________________________________________________

Single engine hours: Fixed ______ Retract ______ Multi engine hours: ______

Hours flown: Total _____ Last 6 mo. _______ Piper Cherokee hours: _______

Models usually flown: _______________________________________________

Aircraft accident? Yes___ No____ If yes, please explain __________________

________________________________________________________________

Medical: Class _________ Expiration Date_________ Restrictions ___________

Employer:_______________________________ Position__________________

Address ____________________________________ Years with firm ________

Bank Reference ___________________________________________________

Other Credit references _____________________________________________

________________________________________________________________

If accepted, applicant agrees to become bound by and expressly adopts the by-laws
and the flying rules and regulations of Bluffton Sky Pirates, Inc.

Applicant's signature _______________________________ Date __________