Membership Application

Date____________  New___   Renewal___    Individual $15___ Family $25___

Name(s)_______________________________________Birthdate_________

Address_______________________________________________________

City___________________________State_____  Zip____________

Phone__________________ E-mail_______________________________

Email address (To receive your newsletter )____________________________

Newsletters will be emailed to you.. If you do not have a computer or access to the internet and need a paper copy please indiacte  HARDCOPY in email address space

USUA Member? (Y,N)_________ Member #______________________

Present aircraft owned_____________________________________________

Other flown or interested in__________________________________________

Flying Hours:  Ultralight        Dual____________  Solo______________

Gen. Aviation        Dual____________  Solo______________

Comments, Special skills, anything you'd like Us to know about you ? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ _________________________________________________________