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Please complete all of the applicable blanks below. Dues for new members are pro-rated the first year you join based on the

number of months left in the current year. Annual dues for regular members are $18.00 and must be paid NLT the February

meeting of the current year. (Hand to, or mail to: Joanne Warner, Treasurer EAA Chapter 35, 719 Oak Hills Road,

Pipe Creek, TX 78063. Phone: 830.510.4334, e-mail: njwarner@indian-creek.net.)

NAME SPOUSE NAME

ADDRESS CITY

STATE ZIP+4 HOME PHONE

BUSINESS PHONE CELL FAX

E-MAIL National EAA#

Would you be willing to receive our Chapter 35 Newsletter electronically? Yes

Do you have a particular area of interest or Hobby: (USE BACK IF NECESSARY)

Type of employment (optional)—Retired, Student, etc.

Previous employment aviation related:

Military experience:

Would you be wiling to help with Young Eagles? As a ground helper? As a pilot?

Would you be willing to present a program? Yes Topic

Would you be interested in serving on a committee? Yes Committee

Would you serve as a chapter officer? Yes:

Aircraft currently building: Status:

Aircraft currently restoring: Status:

Aircraft you have built or restored in the past:

Future project:

Aircraft you own: Aircraft you fly:

Pilot certificates: (Underline Certs) A – Private; B – Commercial; C – Instruments; D – Multi-engine; E – ATP;

F – Seaplane; G – Helicopter; H – CFI; I – CFI-I; J – Ultralight; K – Student; L – Ready to start; M – Glider.

Aircraft Maintenance Skills: (Underline Skills) 1 – A&P; 2 – IA; 3 – Sheet metal; 4 – Dope & fabric;

5 – Composites; 6 – Welding; 7 – Wood; 8 – Electrical; 9 – Engine maintenance; 10 – Avionics; 11 – Auto Engines

Other Talents:

Additional Comments (use back if necessary):

Most interesting/unusual aircraft you’ve been associated with (use back if necessary):

Office use only: Badge: DB: MD: Nat: Renewal