Application Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Email *Home NumberCell NumberWork NumberEmployerDrivers License Number and StateDate of BirthPilot Info *Student PilotPrivate or Commercial PilotCFI or CFIIApproximate Number of HoursDo you have a valid medical certificate. If not would you be able to pass the physical? Reference 1: Name and Phone NumberReference 2: Name and Phone NumberI am familiar with the By-Laws, Rules, and Regulations of The Flying64th, Inc. and I agree to abide by them if elected to membership. *YesNoNameSubmit