Membership Application
After submitting the following form a representative of the club will get in touch with you to obtain payment information. We accept major credit cards only -- debit cards, cash and checks are not permitted.
Contact Information
First Name:
Last Name:
Email Address:
Address:
City:
State
ZIP:
Work Phone:
Evening Phone:
Cell Phone:
In emergency notify:
Emergency Phone:
Pilot Information
Pilot Certificate Number:
Date of birth (yyyy-mm-dd):
Flight Physical Expiration (yyyy-mm-dd):
Last Biannual Flight Review (yyyy-mm-dd):
Aircraft authorized to fly:
Driver's License Number:
State Issued:
Date Issued (yyyy-mm-dd):
Ratings:
Student
Private
Instrument
Commercial
Multiengine
CFI
CFII
ATP
List a reference other than a relative
Name:
Phone:
Address:
Legal History
It is the policy of the Myrtle Beach Flying Club to verify driver's records with the DMV. The Club reserves the right to query the FAA regarding the pilot's flight history. If the answer to any of the following questions is yes, please provide complete details in the "Details" field below.
Have you ever been convicted of (or pleaded no contest to) a DWI offense?
Have you ever had your Pilot or Driver's license suspended or revoked?
Have you ever been convicted of (or pleaded no contest to) any offense involving substance abuse?
Comments
