Kettle Moraine EAA Chapter 1158
West Bend, Wisconsin, USA

EAA Chapter 1158 Membership Application 
Name:_______________________________________   Phone:__________________

Spouse's Name:_________________________________________________________

Street Address:________________________________________________________

City, State, Zip:______________________________________________________

EAA Number:______________________........Expiration:___________________

E-mail Address:________________________________________________________

Home Page Address: http://_____________________________________________

Sponsoring EAA 1158 Member (if any): __________________________________

Please check appropriate statements below:

Current pilot:_____...Ratings:_________________________________________

Past pilot:_____      Future pilot:_____      Aviation enthusiast:_____

Current airplane owner:_____...Type owned:_____________________________

Future airplane owner:_____    Renter:_____

Builder:_____.........Type of plane being built:_______________________

An initiation fee of $5 pays for a name tag.  Annual dues are $40.  If
it is now between Jan 1 and Oct 31, write your check for $45.  If it
is now between Nov 1 and Dec 31, you pay only the initiation fee, so
write your check for $5 (you will be billed for next year's renewal).

Send your check, payable to "EAA Chapter 1158", to:

                      Howard Kaney, Membership Chairman
                      EAA Kettle Moraine Chapter 1158
                      310 Aerial Drive
		      West Bend, WI  53095




Welcome Aboard!