Personal InformationFirst Name *Last Name *Street Address *Address Continued County *City *State *Zip Code *Spouse Name Spouse Contact Phone Occupation Business Work Phone Home Phone *Cell Phone *Email *Website Address Emergency Contact *Emergency Contact Phone *ID for Home Base Airport *FBO *Pilot Certification Number *Medical Expires *Class *BFR Expires *Height Weight (lbs) Driver License Number *Driver License State *Date of Birth *
Flying Time Total Hours *IFR *MULTI Other As of (mm/dd/yyyy) *
Airplane Year Airplane Make Model Model No. Airplane Call Sign N Speed Number of Seats Hourly Value of Operating Available Load Capacity(Load Capacity minus pilot, fuel, etc.) Have you ever been P.I.C. in a flying accident or incident? *Has you pilot's license ever been suspended or revoked? *If you answered 'yes' to either question above, please describe circumstances
Additional Information check all that apply:Do you speak another language? If yes, Language (s) Spoken: Schedule Availability
How did you hear about Angel Flight?
How Can You Help Us?Many Angel Flight members lend valuable assistance beyond mission piloting. Please indicate below how you may be able to help by checking all that apply: Extra Help
Membership AgreementBy submitting this application, I hereby affirm that all information I have provided with this form and supporting documentation is accurate and correct. I agree to timely inform Angel Flight of any changes to this information, including andy revocation, suspension, or other FAA enforcement actions against me. I further agree to abide by all applicable Federal Aviation Regulations, including those related to pilot currency, and any applicable standards or limitations contained in applicable pilot operating handbooks, including weight and balance restrictions, for any aircraft that I may operate for an Angel Flight coordinated mission.. I understand that I remain, at all time, pilot in command of any mission that I undertake for Angel Flight and that I am solely responsible for the safety of that mission. I also understand and agree that membership in Angel Flight is a privilege and understand that such membership is subject to revocation at any time, with or without reason. Finally, I consent to and agree that Angel Flight may verify my pilot rating (s), record of enforcement actions, if any, and other information related to my pilot certificate that may be maintained by the FAA. I Agree *
Upload Supporting DocumentsLicense *Picture ID *Medical *Log Book-last 2 pages Declaration page only-if you own plane