| Title |
|
(R) |
| Initials |
|
(R) |
First Name
|
|
(R) |
Last Name
|
|
(R) |
| Address |
|
(R) |
|
|
|
Suburb / City
|
|
(R) |
| State |
|
(R) |
Post Code
|
|
(R) |
Home Phone Number
|
|
|
At least one telephone number is required.
|
Work Phone Number
|
|
|
Mobile Phone Number
|
|
|
Email
|
|
|
Although not required, you will miss out on most
Club communication if you do not supply one. |
Would you
like to be on the mailing list?
|
|
|
If not, you
will not receive
newsletters and other communications from the board |
Would you
like to purchase a custom made Canberra Aero Club name badge?
|
|
|
|
The following details
are required only if you plan
on flying Aero Club aircraft (and are consequently also sending in the
signed Hiring
Terms and Conditions form).
|
ARN
|
|
|
Medical Due Date
|
|
|
If
you are unsure of the exact dates, just specify the first day of the
relevant month. |
BFR Due Date
|
|
|
License Type
|
|
|
|
| |