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

relationship status

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

If yes, please explain.

Employment

Employer

Company Name

Address

Phone

Start Date +

End Date +

Position

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

Phone Number

Current Certificates and Ratings

Already a pilot? List your Airman's Certificate number and issuance date.

Do you currently hold valid Basic Med or Medical Certificate?

Yes

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. *

clear

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