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Application for Membership
Alleghany Flying Club, Inc.
Greater Cumberland Regional Airport
Cumberland , Maryland 21502
Alleghanyflyingclubsec@gmail.com
www.afc-cbe.com
Personal Information
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
State
*
Zip Code
*
Phone
*
Email Address
*
Gender
Male
Female
relationship status
Married
Single
Birthdate
*
How did you hear about us?
*
Have you ever been convicted of a DWI/DUI/ have you ever been convicted of a felony?
*
Yes
No
If yes, please explain.
Employment
Employer
Company Name
Address
Phone
Start Date
+
End Date
+
Position
Supervisor/Manager
Reason for Leaving
May we contact?
*
Yes
No
Phone Number
Current Certificates and Ratings
Current Certificates
*
I want to learn to fly
I am already a student
Recreational
Private
Commercial
ATP
Instructor
Current Ratings
Instrument
Single Engine Land
Single Engine Sea
Multi Engine Land
Multi Engine Sea
Helicopter
Glider
A&P mechanic
Already a pilot? List your Airman's Certificate number and issuance date.
Do you currently hold valid Basic Med or Medical Certificate?
Yes
No
If yes please list date of issuance.
Type and Model Pilot in Command experience
Please list any relevant recent flight experience. Include total time to date.
What are your Aviation goals?
*
Have you ever been cited by the FAA for any violations or been involved in an accident while acting as a Pilot or Co-Pilot? If "Yes" please explain.
*
Yes
No
No
I warrant that the answers given are true and complete to the best of my knowledge and belief, and that no material has been withheld.
*
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