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The Secretary, Northam Aero Club (Inc) PO Box 247 Northam WA 6401 Date ..........................................2009.
I desire to be elected as a member of the Northam Aero Club (Inc) and enclose the sum of $60.00 being my nomination fee of $10.00 and the annual subscription of $50.00. ( Annual subscription is valid 1st January until 31st December)
Applicant's Name : (Block letters)......................................................................................... Date of Birth :.............................. Occupation : ............................................................... Residential Address :....................................................................................................... ......................................................................................................................................... E-mail address:................................................................................................................. Postal Address :.................................................................................................................. Telephone number : Home............................Bus............................ Mobile............................ Pilot Licences held: Student's Pilot Licence N°.......................................Date of issue:.................................... Other Licences ...................................................... Date of issue:.................................... Club Member proposing :...................................................Signature:................................ Club Member seconding:....................................................Signature:................................ References : If unknown to any member, two written character references should be attached to this application and the names of these referees written in the space below. Names of referees :..........................................................................................................
In consideration of my being elected as a member of the Northam Aero Club (Inc) or granted the facility of membership, I hereby agree that before flying in any of the Club aircraft or taking part in any Club activities, I will acquaint myself with the memorandum and articles of association,Club Constitution and bylaws and Operations Manual, I further agree to observe, perform and be governed by the same and any amendments thereof or additions thereto which maybe hereafter made.
DATED this .....................................day of .......................20.. Applicants' Signature:................................................................. Witness name (Block letters)...........................................Signature:..............................
The following must be signed by the parent of any applicant under the age of 18 years.
Declaration by Parent or Guardian I,.......................................................................................... Address............................................................................ ............................................................................................ Occupation:..................................................................... Hereby declare that I am the legal parent/Guardian of the above named applicant for membership to the Northam Aero Club (Inc).I have read and understand the above application form and hereby consent to him/her making this application. On behalf of my Son/Daughter/Ward and for the consideration to accept and be bound by the terms of the same and to accept full responsibility for liabilities or charges therein stated I agree which he/she incurs by reason thereof. Signature of Parent/Guardian................................................................... BACK to THE MEMBERSHIP PAGE
Form 1/1/2009 |