Membership Application

          Type of Membership

       Individual  Family  Company or Corporation

         Individual Member Information
        First Name 

       Last Name 

            Address 

  City, State Zip  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory

    Home Phone 

Business Phone 

                Email 

        Profession 

     Date of Birth 

If Family - Additional Family   Company/Corporation Members

Name       -        Relationship  or Position    -        

Company or Corporation Information

Contact Name

              Name 

          Address 

City, State Zip  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory

            Phone 

Membership Referral*

How did you hear about Air Club 2000?

           Source 

So we may thank the member who referred you to us, please provide their name and membership number.
*Referral benefit valid for full-price memberships only.

Member Name 

          Address 

 Membership# 

Payment

   Credit Card  Visa MasterCard American Express Discover Diners Club

Account Number 

Exp. Date  1 2 3 4 5 6 7 8 9 10 11 12 / 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Terms & Conditions

  I agree by submitting this application, the prospective members agree to abide by such Club Terms and Conditions as may now or hereafter be promulgated for the common benefit of the membership.