MEMBERSHIP APPLICATION for Calendar Year 20______

EAA Chapter 563   1320 W Bird Blvd   Peoria IL 61615

To join, you must have the corresponding membership in the national EAA. Annual chapter dues are $40, Individual or Family. New members may pro-rate their dues to the month. Fields underlined are required for new applications; all others are optional. Contact information is placed in the chapter Directory stored on the chapter web site, on a page protected by a password given to members. You may request neither your phone nor your e-mail information be placed there.

[ ] New or [ ] Renewal—enter only fields changed from last year

Name: Address: EAA member number: expires: Phone: e-mail for announcements: For Family membership, please list the family members and their EAA number: Willing to help at Chapter events: Year first joined EAA: Year of first airplane ride: Aviation Licenses and Ratings: Professional and Military Aviation: Aircraft, factory or projects—past, present, and future: Aviation or construction skills to share: