Lebanese Aircraft Owners & Pilots Association

Membership Application Form

PERSONAL INFORMATION

Name:_____________________________________.First name:_____________________Sex M □ F□

Address:_________________________________________________________________

Phone:________________  Fax__________________.Mobile_______________________

Email ______________________________..Date Of Birth__________________________

Occupation___________________________.

Certificate/Rating

Pilot license:

Student Pilot □  Private Pilot □ Commercial Pilot □  Instructor □ ATP □

Rating

Multi-Engine□ Night □ Instrument □ Float □ Other____________________

Aircraft Owner : Yes□  No □

Make _____________  Model _______________ Registration ______________________

Payment Option :

1 year:  $ 75.00 □   2 Years: $100.00  □

Association: $ 175.00 □ Corporate: $ 275.00 □ Life Time Member: $ 750.00 □

Payment Method

Cash enclosed________ Check # __________________

Credit Card Type: Visa / Master / Amex#.___________________.Exp____  CVC______

Signature __________________.Date _____________________