Name:_______________________________________ Phone:__________________
Spouse's Name:_________________________________________________________
Name Tag Spelling (member and spouse) :_________________________________
Street Address:________________________________________________________
City, State, Zip:______________________________________________________
EAA Number:______________________........Expiration:___________________
E-mail Address:________________________________________________________
Home Page Address: http://_____________________________________________
Newsletter Preference:
Online (in color, archived for your referance, E-mail Notification) ____
or Hardcopy (black and white only, mailed when time is available) ____
Sponsoring EAA 1158 Member (if any): __________________________________
Please check appropriate statements below:
Current pilot:_____...Ratings:_________________________________________
Past pilot:_____ Future pilot:_____ Aviation enthusiast:_____
Current airplane owner:_____...Type owned:_____________________________
Future airplane owner:_____ Renter:_____
Builder:_____.........Type of plane being built:_______________________
An initiation fee of $5 pays for a name tag. Annual dues are $40. If
it is now between Jan 1 and Oct 31, write your check for $45. If it
is now between Nov 1 and Dec 31, you pay only the initiation fee, so
write your check for $5 (you will be billed for next year's renewal).
Send your check, payable to "EAA Chapter 1158", to:
AJ Brandt, Membership Chairman
EAA Kettle Moraine Chapter 1158
310 Aerial Drive
West Bend, WI 53095
Welcome Aboard!