HOKIE FLYING CLUB, INC
Blacksburg, VA
Membership Application
I. Name________________________________________________________
Address________________________________________________________
City___________________________State________Zip_________________
Telephone(home)____/______–_______(Work)____/______–___________
Cell Phone____/______–_________e-mail:___________________________
Occupation_____________________________________________________
II. License type_______________________Number_____________________
Ratings________________________________________________________
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 Has your Pilot’s certificate ever been revoked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)
1)________________________________________________________________
2)________________________________________________________________
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