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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 ----------------------------------------------------------------------------------------------------- 1. NAME MR./MRS./MISS ---------------------------------------------------------------------------------------------------- 2. DATE OF BIRTH AGE ---------------------------------------------------------------------------------------------------- 3. MARITAL STATUS SINGLE/MARRIED ---------------------------------------------------------------------------------------------------- 4. IF MARRIED, NAME OF SPOUSE -------------------------------------------------------------------------------------------------- 5. NAME AND AGE OF CHILDREN a) Name………………………………………. Age……………. UNDER 12 YEARS OF AGE b) Name………………………………………. Age……………. c) Name………………………………………. Age……………. -------------------------------------------------------------------------------------------------- 6. OCCUPATION/PROFESSION .................................................. -------------------------------------------------------------------------------------------------- 7. NAME AND ADDRESS OF EMPLOYER OR IF SELF EMPLOYED NAME AND ADDRESS OF BUSINESS & TELEPHONE NO. --------------------------------------------------------------------- 10. PERSONAL ADDRESS AND TEL: NO & E-MAIL ------------------------------------------------------------------------------------------------- 9. PILOT LICENCE TYPE RATING (PPL/CPL) LICENCE NUMBER ……………..……………..……………..……………..……………..…………….. --------------------------------------------------------------------------------------------------- 10. IF YOU ARE A MEMBER OF ANY OTHER CLUBS, GIVE NAMES a) ……………………………………………………… b) ……………………………………………………… -------------------------------------------------------------------------------------------------- 11. GIVE DETAILS OF AIRCRAFT YOU CURRENTLY FLY a) ……………………………………………………… b) ……………………………………………………… -------------------------------------------------------------------------------------------------- 12. GIVE NAMES OF MEMBERS YOU PERSONALLY KNOW a) ……………………… b) ……………………… c) …………………………… -------------------------------------------------------------------------------------------------- 13. DO YOU WISH YOUR MEMBER STATUS TO BE SINGLE/FAMILY/FRIEND/UPCOUNTRY/ABROAD …………….. -------------------------------------------------------------------------------------------------- 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:…………… |
Application Form 
