Membership Application – Coastal Skies Aero Club

Personal Information

Member Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

MM slash DD slash YYYY

Driver's License Number*

Phone*

Email*

How did you hear about Coastal Skies Aero Club?

Were you referred to Coastal Skies Aero Club? If so, by whom?

Emergency Contact

Emergency Contact Name*

First Last

Emergency Contact Phone*

Relationship to you*

Pilot Information

Certificate Number

Certificates Held

None

Sport

Commercial

Student

Private

ATP

Ratings Held

None

Multi

CFI

MEI

Instrument

Seaplane

CFII

MEII

Endorsements Held

None

Complex

High Altitude

High Pro

Tailwheel

Total Flight Hours

Hours last 90 days

Last flight date

MM slash DD slash YYYY

BFR Date

MM slash DD slash YYYY

Last Medical Date

MM slash DD slash YYYY

Class of medical

None

Class 3

Class 2

Class 1

Have you ever had an airplane accident or have been cited for a violation of Federal Aviation Regulations?

Yes

If yes, please explain

Have you have ever been a member of another flying club, please give the Club Name and Contact Information below.

Payment Information

Name on Credit Card*

First Last

Credit Card Number*

Exp Date*

Security Code/CVV*

Billing Zip Code*

Membership Application Fee is non-refundable

I understand and agree that once the membership fee is assessed it is non-refundable.

Coastal Skies Aero Club will assess the membership fee upon successful application with the club using this form. This membership fee once assessed is non-refundable

Waiver of Liability

Aircraft Use Agreement Acknowledgement*

I have read and agreed to the Aircraft use agreement.

Coastal Skies Standard Operating Procedures*

I have read and agreed to the Standard Operating Procedures.

Waiver of Liability Acknowledgement*

I have read and agreed to the Waiver of Liability.

Permission To Run Credit Card Acknowledgement*

I have read and agreed to the Permission To Run Credit Card.

Obtaining Renters Insurance*

I understand that Coastal Skies Aero Club does not accept Avemco insurance policies.

Upload Documents

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 128 MB.

Securely upload your US issued Photo ID, US Issued Birth Certificate, or unexpired passport, All FAA Certificates, FAA Medical, Logbook endorsements and, Rental Insurance. You can always bring them with you to the orientation as well. ***Please note*** Coastal Skies Aero Club must have all documentation PRIOR to your first flight.

Electronic Signature

Guardian Electronic Signature

I am the parent or legal guardian and accept the terms of this agreement on behalf the "Member"

Ready to join Coastal Skies Aero Club?

Coastal Skies Membership Application

Personal Information

Emergency Contact

Pilot Information

Payment Information

Waiver of Liability