Date___________________
Please accept my application for membership in the Maine Powerchute Association. I am providing the following information for application purposes only.
I understand current membership dues are $25.00 annually.
Name:________________________________________________________
Address:______________________________________________________
City/State/Zip:__________________________________________________
Home/Cell Phone:__________________________________________________
E-mail:________________________________________
Work Phone: ___________________________________________________
Affiliation In membership (ASC, EAA, USUA, etc):_____________________
FAA Rating (Sport Pilot, Private, commercial, etc):______________________________
Years flying PPC:_______________________________________________
Total years flying (all aircraft):______________________________________
Total flight hours (all aircraft):_______________________________________
PPC type(s) owned:______________________________________________
Enclose $25.00 annual dues, and $35 for family membership. You'll be notified of all upcoming meetings and events.
Please fill in all necessary sections and return to:
Bonnie Davis Micue
PO Box 13Warren ME 04864-0013(Items in RED must be filled out - all others are optional)
Maine Powerchute Association
MembershipApplication
