Application for the Hokie Flying Club, Inc.

Blacksburg, VA
Membership Application

I. Name________________________________________________________
Cell Phone____/______–_________e-mail:___________________________
II. License type_______________________Number_____________________
Instructor ratings_________________________________________________
Certificate number____________________Date________________________
Hours: Total____________________________________________________
Tail wheel____________Const. Speed Prop_________Retract____________
Multi. Engine____________Night__________Instrument________________
Solo/PIC__________Cessna 150/152___________Cessna 172____________
Cross-country________________As Instructor__________
III. Birth date_______________Place______________US Citizen?_________
Date of Last Medical__________________________Class_______________
Date of Last Flight Review_________________________________________
Date of Last Proficiency Check______________________________________
IV. Last Wings program level achieved?_______________Date____________
If “Yes” to any of the questions below (V – IX), Attach Explanation
V. Do you have any waivers, limitations conditions, attached to your medical certificate. Yes/No
VI. Has your Pilot’s certificate ever been revoked or suspended? Yes/No
VII. Have you ever been cited for any violation of the FARs? Yes/No
VIII. Have you ever been involved in an aircraft accident? Yes/No
IX. Have you ever been convicted of or pleaded guilty to a felony or for drunken driving? Yes/No
X. Provide two personal references including Names, addresses, and Telephone #’s (pilots preferred)



Club Information

The Hokie Flying Club is a member owned and operated Club. Well maintained, reasonably priced aircraft are available to fly only because club members volunteer their time and talents. With this in mind, please answer the next three questions:

We hold 11 monthly meetings per year. How many would you attend?


How many hours per month of your time can you commit to giving the Club? __________________

In which areas of Club operation would you like to donate your time:
____ Aircraft Maintenance ____ Finance/Accounting ____ Leadership
____ Social ____ Membership ____ Programming ____ Newsletter ____ Administrative
____ Safety ____ Long Range Planning

I, the undersigned, do hereby apply for membership in the Hokie Flying Club, Inc. (also doing business as the Blacksburg Flying Club and hereafter referred to as the “Club”). I understand that the Club is a non-profit organization incorporated under the laws of the Commonwealth of Virginia. I agree to adhere to the rules and regulations of the Club and be governed by them while exercising my privileges as a Member. I specifically acknowledge having read the Club ByLaws and Flight Operations documents and I have satisfied any questions related to these rules and operational guidelines of the Club.

I also understand that I shall forfeit my privileges as a Member if Club aircraft are flown or operated by me, or permitted to be flown or operated by me, either on the ground or in the air, in violation of Federal Aviation Regulations or Club Rules and Regulations; and that I operate aircraft owned or controlled by the Club without personal liability of the Club or its Members; and that any passengers carried while I am in command of Club aircraft shall at no time be at the risk of the Club or any other of the Members.

I authorize the Club to contact credit and/or flying references in the attempt to determine my suitability for membership. I also understand that my initial six months of membership are probationary in nature and that my membership may be terminated with refund of initiation fee and deposit during that period.

Signature of applicant: ____________________________________________
Date ( D/M/Y ): ____/____/____
Important: Please attach a copy of your Airman’s Certificate, photo ID and Current Medical Certificate