Lebanese Aircraft Owners & Pilots Association

Membership Application Form

PERSONAL INFORMATION

Name:……………………………………..First name:…………………………Sex M □ F□

Address:…………………………………………………………………………………….

Phone:……………………  Fax……………………….Mobile……………………………

Email ………………………………………..Date Of Birth……………………………….

Occupation…………………………………..

Certificate/Rating

Pilot license:

Student Pilot □  Private Pilot □ Commercial Pilot □  Instructor □ ATP □

Rating

Multi-Engine□ Night □ Instrument □ Float □ Other…………………………..

Aircraft Owner : Yes□  No □

Make ………………  Model …………………. Registration …………………………….

Payment Option :

1 year:  $ 50.00 □   2 Years: $75.00  □

Association: $ 150.00 □ Corporate: $ 250.00 □ Life Time Member: $ 500.00 □

Payment Method

Cash enclosed…… Check # ……………………..

Credit Card Type: Visa / Master / Amex#.............................................Exp…. 

Signature ……………………………….Date …………………