JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Lockhart Flying Club Membership Application
Questions? Let us know at
LockhartFlyingClub@gmail.com
!
* Indicates required question
Email
*
Record my email address with my response
Full Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Insurance Information
Date of Birth
MM
/
DD
/
YYYY
Do you currently posses a pilot certificate?
*
Yes
No
Other:
What is your certificate number (if applicable)
Your answer
Additional ratings, if applicable:
Your answer
Medical Class
*
Your answer
Medical Expiration
*
MM
/
DD
/
YYYY
Are you a citizen of the United States?
*
Yes
No
Have you been convicted of a felony?
*
Yes
No
If yes, explain:
Your answer
Date of Last Flight Review
MM
/
DD
/
YYYY
Hours (if any) in a Cessna 150
Your answer
Hours (if any) in a Cessna 182
Your answer
Hours (if any) in a Piper Cherokee 180
Your answer
About You
Hobbies or other interests
Your answer
Anticipated use for Club Aircraft?
Your answer
Your favorite plane or a plane you'd like to see the club acquire someday:
Your answer
Flying History
Total Flight Hours
Your answer
Please list the types of aircraft you've flown, along with the number of hours and the date last flown:
Your answer
Emergency Contact Information
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Documentation
Please email a copy of your driver's license, pilot's license (if any), and medical certificate to
LockhartFlyingClub@gmail.com
Emailed license and medical certificate?
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
