Apply For Membership

1. Member Details

Membership Type: *

Duration: *

Surname: *

Given Names: *

Preferred Name: *

Title: *

Date of Birth: *

Email Address: *

Home Phone:

Business Hrs Phone

Mobile Phone *

Fax:

Emergency Contact Name:

Emergency Contact Number:

2. Residential Address

Country: *

Address:

Suburb / Town:

State:

Postcode:

3. Postal Address
Same As Residential Address?

Country:

Address:

Suburb / Town:

State:

Postcode:

4. Medical Declaration

Are you over 75 OR do you have any of the following conditions:

Epilepsy
Diabetes
Heart condition/disease or paralysis
Mental illness (medicated or otherwise)
Any other medically significant safety related condition?

5. Additional Details

Nominated Flight Training Facility *

Do you hold a CASA issued flight crew licence or equivalent from another organisation? *

6. Payment

I understand that online transactions incur fees. I wish to help further by giving a little extra ($1.50).

Cost

GST

Joining Fee

Total

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Membership Application