PLEASE PRINT AND COMPLETE FULLY AND MAIL TO:

Palmetto Sport Aviation Association, Inc.

EAA Chapter 242

1400 Jim Hamilton Blvd., Hangar 69

Columbia, SC 29205-4458

Name_____________________________________________________________ DOB______________

Spouse____________________________________________________________ DOB ______________

Street________________________________________________________________________________

City/State/Zip_________________________________________________________________________________

Phone (H) ___________________(W) __________________ (C) __________________ (Fax) ___________________

Spouse (W) _________________ National EAA Number: __________________ Expiration Date: _________________

Employed by:_________________________________________________________________________________

Certificate Type/Ratings: r Student r PVT r COM r INST r Other___________________________________

Currently Flyable Aircraft Owned: Manuf:___________________ Model__________________ N#____________

Aircraft Project Under Construction:_______________________ Model__________________ N#____________

If you want to receive e-mail from the chapter (news, meeting reminders, newsletters, etc.):

E-mail: (H)____________________________________________________________________________________

E-mail: (W)___________________________________________________________________________________

E-mail: (Spouse)_______________________________________________________________________________

Newsletters are sent via e-mail , check if hardcopy is required r

Committee participation: There is no better way to get to know other chapter members than to serve on a committee. No experience is necessary, come on out and join the fun! Please indicate any committee you may be interested in serving on: r Food Service r Newsletter r Program r Young Eagles r Membership r Sport Aviation Center (SAC) Operations r Computer r Library

If you are a builder, you may need to use the chapter workshop at Owens Field. There is an extra charge for this which covers the cost of some basic supplies and a key to the workshop. The initial fee is $20 year, $10 year thereafter.

Chapter Dues: $30/year r NEW MEMBER r RENEWAL

Workshop Dues: $10.00/year r

Amount Enclosed: _______________(Please make checks payable to Palmetto Sport Aviation Assn.)

Chapter dues do not include your national membership dues. Visit the EAA website at www.eaa.org and join there, or you can call the toll-free number for EAA at 1-800-JOIN EAA (1-800-564-6322). Their hours are 8 a.m. - 7 p.m. (Central time) on Mondays, and 8 a.m. - 6 p.m. on Tuesdays - Fridays.

I was recruited by:__________________________________________________________ 

Club Use Only: r Treasurer r Secretary r Newsletter r Workshop key r Mentor_________________________

Note: Please renew as soon as you receive this form. Our membership year runs from January 1-December 31.

YOU WILL BE DROPPED FROM THE MEMBERSHIP IF NOT RENEWED PRIOR TO MARCH 1.