B47HA MEMBERSHIP APPLICATION

(PLEASE SELECT PRINT PREVIEW, THEN PRINT ON YOUR COMPUTER – AND PRINT THE APPLICATION
PLEASE COMPLETE ALL ITEMS IF APPLICABLE AND MAIL TO: BELL 47 HELICOPTER ASSOCIATION INC. 28931 BRINK RD. SHATTUC, IL. 62231

HOW DID YOU HEAR ABOUT B47HA __________________________________________________________________________

RENEWAL MEMBER #_____________________MEMBERSHIP $30 RENEW (BTW we check for your membership # – if you have never had one – use new member option)____             INDIVIDUAL $125____ GOLD (BUSINESS ADVERTISING INCL) WITH FRAME $1000______ GOLD W/O FRAME $750________
NAME______________________________________________________________________________________________________
ADDRESS______________________________________________________________________________________________________
CITY
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STATE
_______________________________ZIP_________________________COUNTRY______________CHECK #________
PHONE OFFICE__________________________________CELL______________________________HOME___________________
E-MAIL___________________________________________________
HELICOPTER OWNED OR RENTED REGISTRATION NUMBER: N_____________
BELL 47 PILOT FLIGHT HOURS_____________________NO FLIGHT EXPERIENCE CHECK HERE____
PILOT OR MECHANIC RATING/S_____________________________________
PROXY OPTION: I HEREBY PROXY MY VOTE TO PRESIDENT JOEY RHODES. (PLEASE SIGN & DATE)___________________________________