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TO MAIN COFA PAGECOFA BYLAWS, Appendix B. APPLICATION FOR MEMBERSHIP
(page 1 of 2)
Effective date _Nov 12, 1997_ Supersedes Appendix B, dated ___ n/a ___
CENTRAL OHIO FLYERS ASSOCIATION
I, _____________________________________________________________________
(printed name: first, middle, last)
hereby apply for Active membership in the Central Ohio Flyers Association
(COFA INC.).
Enclosed is $_________ (and a $25.00 processing fee).
I understand that, if within 60 days of becoming a member I am dissatisfied,
upon written request 90% of $_________ will be refunded. Should I resign
after 60 days, I understand that any refund will be based on Article II,
Paragraph H of the COFA Bylaws. I understand that the current refund amount
is $_______, and that it is subject to change. I also understand that should
I experience an unexpected event after 60 days, but within 6 months of
joining (e.g. unexpected job transfer, sudden loss of medical), upon written
request 90% of $_________ may be refunded to me. I understand that the
validity and timeliness of such a hardship request shall be determined
solely by the Trustees.
I understand that all monies submitted with this application will be returned
in full should I not be accepted for membership.
Date of Birth:_________Social Security Number:__________________________
Home address:___________________________________________________________
City, State, ZIP:_______________________________________________________
Home phone number(s):___________________________________________________
Occupation:_____________________________________________________________
Employer:_______________________________________________________________
Business address:_______________________________________________________
City, State, ZIP:_______________________________________________________
Business phone number(s):_______________________________________________
Other phone numbers (i.e. fax, cellular):_______________________________
E-mail address:_________________________________________________________
Name of spouse:_________________________________________________________
CENTRAL OHIO FLYERS ASSOCIATION
I have enclosed copies of the following documents with this application...
_____Driver's License.
_____Pilot Certificate.
_____Medical Certificate.
_____Logbook endorsement showing Flight Review (FAR 61.56).
_____Last two pages of my logbook.
_____Logbook endorsements for checkouts in ___C172, ___C182, ___C210.
I understand that a copy of my latest Flight Review (e.g. BFR) and a copy
of my latest Medical Certificate shall always be kept on file with the
appropriate trustee/officr. Should I fail to update this information, I
understand that I shall not fly COFA aircraft until I do so.
To date I have logged... ______ hours in retractable gear aircraft
_____ hours in a C172. ______ hours in a C182. _____ hours in a C210.
Please answer the following questions. Have you ever...
...had any aircraft accidents, incidents or claims, or had your pilot certificate
surrendered, suspended or revoked? __Yes __No
...had your drivers license surrendered, suspended, revoked? __Yes __No
...been arrested for or charged with operating a motor vehicle
or aircraft under the influence of alcohol or drugs? __Yes __No
...been convicted of or pleaded guilty or no contest to any
felony, crime, or misdemeanor other than parking violations? __Yes __No
...had an insurance company cancel, or decline to insure or
refuse to renew your aircraft or auto insurance coverage? __Yes __No
If you answered yes to any questions, please explain below or on a separate
sheet.
_______________________________________________________________________
I UNDERSTAND THAT COFA AIRCRAFT SHALL NOT BE USED FOR COMMERCIAL PURPOSES.
I estimate that I will fly _____ hours per year in COFA aircraft.
This information and the supporting documentation I have submitted is true
to the best of my knowledge and belief. I certify that I have reviewed,
with a trustee, the rules and regulations of COFA INC, and that if accepted
for membership I will follow the club's bylaws.
_________________________________________________ __________________
(Signature) (date)