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TO MAIN COFA PAGECOFA BYLAWS, Appendix C. APPLICATION FOR FAMILY
MEMBERSHIP (page 1 of 2)
Effective date _Nov 12, 1997_ Supersedes Appendix C, dated ___ n/a ___
CENTRAL OHIO FLYERS ASSOCIATION
I,____________________________________________________________________,
(printed name of Active member: first, middle, last)
active member in good standing of COFA INC, hereby apply for Family Membership
for the following member of my immediate family...
________________________________________ _____________ _______________
(printed name of applying Family Member) (relationship) (date of birth)
I certify that this person is a member of my immediate family, and if a
son or daughter this person is my dependent, under the age of 24, and that
this person is living in my household.
I understand that the initial fee for this member is $_______, and that
this membership is renewable each year at a cost as set forth in the bylaws.
I UNDERSTAND THAT I AM TOTALLY RESPONSIBLE FOR PAYMENT OF ANY CHARGES INCURRED
BY THIS FAMILY MEMBER.
I UNDERSTAND THAT COFA AIRCRAFT SHALL NOT BE USED FOR COMMERCIAL PURPOSES.
I estimate that this family member will fly _____ hours per year in COFA
aircraft.
I understand that all monies submitted with this application will be returned
in full should this member of my family not be accepted.
___________________________________________________ __________________
(Signature of sponsoring Active Member) (date)
Family member's Social Security Number:_________________________________
We have enclosed copies of the following documents with this application,
as pertains to this Family Member's application...
_____Driver's License.
_____Pilot Certificate.
_____Medical Certificate.
_____Logbook endorsement showing Flight Review (FAR 61.56).
_____Last two pages of logbook.
_____Logbook endorsements for checkouts in ___C172, ___C182, ___C210.
CENTRAL OHIO FLYERS ASSOCIATION
We understand that a copy of this family member's latest Flight Review
(e.g. BFR) and a copy of this family member's latest Medical Certificate
shall always be kept on file with the appropriate trustee/officer. Should
I or my family member fail to update this information, I understand that
my family member shall not fly COFA aircraft until this is accomplished.
To date this person has logged.. ____ hours in retractable gear aircraft
_____ hours in a C172. ______ hours in a C182. _____ hours in a C210.
Please answer the following questions. Has your family member 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.
_______________________________________________________________________
This information and the supporting documentation we have submitted is
true to the best of our knowledge and belief. We certify that we have reviewed,
with a trustee, the rules and regulations of COFA INC, and that if accepted
as a family member, the club's bylaws will be followed.
___________________________________________________ __________________
(Signature of sponsoring Active Member) (date)
___________________________________________________ _________________
(Signature of applying Family member) (date)