High Altitude Flying Club :: Club Enrollment

Full Name
Age
Address
Email
Phone 1
Phone 2
Date of Medical
Medical Class
AOPA Member
Date of Last Biannual Flight Review
FAA Ratings Held	Student Private Commercial Instrument Multiengine ATP CFI CFII MEI Complex Endorsement
Total Time Prior 12 Months
C172 Total Time
Total Flight Time
Retractible Gear Time
Multi-Engine Time
Accidents-Restrictions-Waivers?
Convictions, suspensions or revocations (FAR violations, drug use, drunk driving)
Physical impairments, waivers or statement of demonstrated ability other than for corrective lenses, limitations or conditions attached to medical certificate? (describe)
Please type the letters and numbers shown in the image.