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EAA CHAPTER 27 MEMBERSHIP FORM

Please fill in the following information and mail with your dues to:
EAA Chapter 27, c/o Bill Jagoda, 43 Derby Road, Rockfall, CT 06481
Dues are $20.00 per year, due on January 1. Make checks payable to EAA Chapter 27

(Please print)

Name: __________________________________________________  Phone: __________________________

Street: ___________________________________________________________________________________

City: __________________________________________________  State: _____ Zip: _______________

EAA Member # _____________________Expires: _____________  Pilot rating held: ______________

E-mail address: ________________________________________ 
We only send our newsletter via email

Aircraft make & model: ___________________________   Flying ___  Building ___  Restoring __

If building or restoring, % completed?: __________

Tell us about your areas of interest: ______________________________________________________

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