EAA Chapter 524
Membership Registration
This form is to be used each year for membership application
or renewal, providing information for receipt of email notices and newsletters,
and for verification of dues payment. Please complete Sections I and III. Keep
Section III for your records (this and your cancelled check will serve as your
receipt). Return Sections I and II to the chapter treasurer with your payment.
Make your check payable to EAA Chapter
524 and mail to Joe Halleman,
I.
Registration Information
Last Name __________________________ First
Name___________________________
Other name(s) if Family Membership
__________________________________________
EAA Membership Number ______________
Phone Number (H)_________________ (C)__________________ (W)_________________
Address__________________________________________________________________
City________________________________ State_____________
Zip_________________
E-mail Address (for receiving notices & Newsletter) ______________________________________
Are you able to receive your newsletter by either e-mail or
through the web? Yes___ No___
Aircraft/Projects/Interests______________________________________________________
__________________________________________________________________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
II.
For Office Use
Member Name
______________________________________________________________
Dues Paid: Check_____ Number_________ Cash_____
Amount $___________
Date:_______________________
Fiscal
Year(Sept.-Aug): 200___
Treasurer’s
Initials___________
_ _ _ _ _ _
_ _ _ _ _ _ _ _ Tear
here. Keep bottom Section for your records_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
III.
Member’s Receipt for EAA Chapter 524 Dues
Member
Name______________________________________________________________
Dues:
Individual Membership: $ 60.00 _______
Family Membership: $
90.00 _______
Date___________________________ Dues
paid for fiscal year(s):_________________