Application

YOU ARE NOW TAKING THE FIRST EXCITING STEP ON BECOMING A
MEMBER OF ONE OF THE FIRST AND MOST SUCCESSFUL FLYING CLUBS IN
THE STATE OF FLORIDA.

Entrance Fee: $2000 for all applicants

Application fee: $50 (non-refundable)

The entrance fee is payable at the time of orientation.

Monthly dues are $90

Renter's Insurance required: min $20,000 hull

YOU MUST ATTEND A BOARD MEETING PRIOR TO ORIENTATION

Your Membership will begin after board approval and attending orientation

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Occupation: *

Current Employer: *

Date of Birth: *

Email Address *

Social Security Number: Required for a credit check *

Have you ever had an aircraft claim, incident or accident? *

FAA PILOT CERTIFICATES HELD

	Check all that apply
Student	Check all that apply
Private	Check all that apply
Commercial	Check all that apply
ATP	Check all that apply
Flight Instructor	Check all that apply
Sport	Check all that apply

Ratings Held (Check all that apply)

Total Pilot in Command total hours: *

Total Pilot in Command General Aviation Hours (After Private Pilot License): *

GA Aircraft Experience (list your aircraft experience and total PIC hours) * 🛈

Date of last flight: *

Total number of hours flown during the last 12 months: *

Please list your goals for joining the FMFC: *

*

	Answer
	Yes	No
As pilot-in-command or as co-pilot have you ever had any violations or actions against your pilot certificate?	Yes	No
As pilot-in-command or as co-pilot have you ever been involved in an aircraft accident or incident involving damage to aircraft, reportable or not?	Yes	No
Has your driver’s license ever been suspended or revoked?	Yes	No
Have you had any automobile accidents in the last five years?	Yes	No
Have you ever had an aircraft claim, incident or accident?	Yes	No
Have you ever been cited or fined for violation of an aviation regulation?	Yes	No
Has your pilot certificate ever been suspended or revoked?	Yes	No
Have you ever been convicted of a felony or are you under indictment for a felony?	Yes	No
Have you ever been convicted of driving a motor vehicle under the influence of alcohol or narcotics, or of reckless driving?	Yes	No
Have you ever been convicted of or are you under indictment in a legal action involving drugs or narcotics?	Yes	No
Have you ever had or been treated for a chemical dependency?	Yes	No
Have you had any moving violations in the last 5 years (If so, please include type, and dates in the comment section below)	Yes	No

Comment:

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Copy of FAA Certificate (Front and Back)

Copy of Driver's license *

Copy of Medical Certificate: Required prior to solo flight

Upload a copy of your most recent Biannual Review: (Student pilots - not required)

Credit Card (Front) *

Please enter credit card information to process your fees (include the card #, Exp date, and code on the back: *

Credit Card (Back) *

Creditworthiness and a background check will be conducted by submitting this application. You are hereby authorizing the Fort Myers Flying Club to obtain a credit report and complete a background check to be used as part of the application process. I also agree that my entrance fee of $1500 is non-refundable once the board approves my membership. I also authorize my credit card to be charged $50 application fee. *

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Fort Myers Flying Club

PO BOX 61197

Fort Myers, FL 33906