Arizona Cloudbusters

Fill out the fields below to tell us about yourself. At the end, submit and save it as a PDF file to go with the rest of your application files.

Personal Information

Full Name

Birth Date

Address

Address 2

City

State

ZIP

Phone #

Emergency Contact Name

Emergency Phone #

Family Membership Relative Name

Occupation

Employed Retired Student Other

Most Recent Employer (or school)

Position Title

Years With

Driver's License

License Number

Expiration Date

State

FAA Medical Certificate

First Class Second Class Third Class BasicMed None

Last Exam Date

Expiration Date

Limitations

Flight Experience

Total Time

PIC Time

PIC in Last 12 Months

Instrument Time

C-172 Time

C-182 Time

BE-33 Time

Last Flight Review (or equivalent) Date

Other Flight Experience

Attestations

Have you ever had a violation or action against your pilot certificate?

Yes No

Have you ever been involved in an aircraft accident?

Yes No

Have you ever been convicted of a felony?

Yes No

Have you ever been convicted of a DUI or drug offense?

Yes No

If you answered yes to any of the above, please explain in detail here.

Terms of Agreement

I certify that the information provided in this application is true and correct to the best of my knowledge.
I understand providing false information may result in denial of application or revocation of membership.
I agree to abide by all applicable federal, state, and local laws and regulations related to aviation.
I agree to abide by the rules and policies of the Arizona Cloudbusters.
I agree to pay all assessed dues and charges in a timely manner.

I agree

After submitting, you will receive a PDF file. Please save this file on your device, and then return to the application steps.

Arizona Cloudbusters Flying Club

Chandler, AZ

Membership Application

FAA Pilot Qualifications

Certificates

Ratings

Endorsements