B47HA MEMBERSHIP APPLICATION

  • PRINT, & COMPLETE ALL ITEMS IF APPLICABLE, ENCLOSE CHECK, AND MAIL TO: BELL 47 HELICOPTER ASSOCIATION INC. 28931 BRINK RD. SHATTUC, IL. 62231 YOUR CHECK #___________OR CASH________ YOU MAY ALSO USE A CREDIT CARD AT OUR WEBSTORE PAGE. NEW INDIVIDUAL $125___GOLD WITH FRAME $1000______GOLD W/O FRAME $750________RENEWALS $30_____DATE_________________CURRENT ROSTER MEMBERSHIP #______________
  • YOU MAY CHECK ROSTER AT http://bell47helicopterassociation.org/site/roster/

NAME__________________________________________________

ADDRESS_______________________________________________

CITY_____________________________STATE___________________ZIP_____________________COUNTRY_____________

PHONE ______________________________E-MAIL_____________________________________

HELICOPTER MODELS OWNED OR RENTED REGISTRATION NUMBER: __________________________________BELL 47 PILOT FLIGHT HOURS_______________________ RATING/S_______________________________________PROXY OPTION: I HEREBY PROXY MY B47HA VOTE TO PRESIDENT JOEY RHODES. (PLEASE SIGN & DATE)________________________________