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Friday, 20 October 2017
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Application Form Print E-mail

Please "CLICK HERE" to download the application form.


 

MOMBASA FLYING CLUB

P.O. BOX 99456

MOMBASA

 

Phone:    475074/5/6                 

Fax:         473981

E-mail:   

 

APPLICATION FOR MEMBERSHIP

    

NOTE:

1).    To be completed by the Applicant

2).    Completed Application form must be submitted within 30 Days of Issue    

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1.     NAME   MR./MRS./MISS 

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2.     DATE OF BIRTH    AGE

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3.     MARITAL STATUS    SINGLE/MARRIED

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4.     IF MARRIED, NAME OF SPOUSE

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5.     NAME AND AGE OF CHILDREN   

 a)    Name……………………………………….    Age…………….

        UNDER 12 YEARS OF AGE                                      

 b)    Name……………………………………….    Age…………….

 c)    Name……………………………………….    Age…………….

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6.     OCCUPATION/PROFESSION ..................................................

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7.     NAME AND ADDRESS OF EMPLOYER   OR  

IF SELF EMPLOYED NAME AND  ADDRESS OF BUSINESS & TELEPHONE NO.

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10.     PERSONAL ADDRESS AND TEL: NO & E-MAIL

        -------------------------------------------------------------------------------------------------

9.     PILOT LICENCE TYPE RATING (PPL/CPL) LICENCE NUMBER

……………..……………..……………..……………..……………..……………..

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10.     IF YOU ARE A MEMBER OF ANY OTHER CLUBS, GIVE NAMES

 a) ………………………………………………………

 b) ………………………………………………………

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11.   GIVE DETAILS OF AIRCRAFT YOU CURRENTLY FLY       

a) ………………………………………………………

b) ………………………………………………………

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12.   GIVE NAMES OF MEMBERS YOU PERSONALLY KNOW                                                      

  a) ……………………… b) ……………………… c) …………………………… 

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13.   DO YOU WISH YOUR MEMBER STATUS TO BE SINGLE/FAMILY/FRIEND/UPCOUNTRY/ABROAD ……………..

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 14.    DECLARATION

(a)     By Proposer and Seconder

We, being members of the Club for more than 2 years, declare that our

Candidate is suitable in all respects for Club Membership.

PROPOSER’S NAME ______________________________________

SIGNATURE _________________A/C NO _____________________________

SECONDER’S NAME ______________________________________

(b)     By the Candidate

I hereby undertake to abide by the Club Rules & Bye Laws and to pay my dues to the Club on the due dates.

 

APPLICANT’S SIGNATURE………………………… DATE:……………

 

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