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 $20.00 annually.

Name:________________________________________________________

Address:______________________________________________________

City/State/Zip:__________________________________________________

Home Phone:___________________________________________________

Work Phone:___________________________________________________

Fax #:____________________E-Mail:_______________________________

Powered Parachute Rating (BFI, AFI):_______________________________

Affiliation In membership (ASC, EAA, USUA, etc):_____________________

FAA Rating (Private, commercial, etc):______________________________

Years flying PPC:_______________________________________________

Total years flying (all aircraft):______________________________________

Total flight hours (all aircraft):_______________________________________

PPC type(s) owned:______________________________________________

Enclose $20.00 annual dues.  $30. for family membership. You'll be notified of all upcoming meetings and events.

Please fill in all sections and return to

Bonnie Micue

PO Box 13

Warren ME 04864-0013

(Items in RED must be filled out - all others are optional)

Maine Powerchute Association

MembershipApplication