Liberty Chapter
PROFESSIONAL LOADMASTER ASSOCIATION MEMBERSHIP APPLICATION
DATE _______________
NAME_________________________________________________________________
ADDRESS______________________________________________________________
CITY___________________________________STATE____________ZIP__________
HOME PHONE (___ )________________WORK PHONE (___)__________________
E-MAIL ADDRESS______________________________________________________
BASE_____________________UNIT____________
COMPANY____________________________________________
TITLE_______________________
ACTIVE DUTY__ RESERVE__ ANG___ RETIRED__OTHER________
AIRCRAFT FLOWN___________________________________________________
SPONSORED/RECRUITED BY___________________________________________
MEMBERSHIP DUES:
ONE YEAR $15.00 _____THREE YEARS $35.00_____LIFETIME $150.00_____
PLEASE INDICATE THE TYPE OF MEMBERSHIP
INITIAL MEMBERSHIP _______ RENEWAL OF MEMBERSHIP______
MAIL REMITTANCE TO
PLA P.O. BOX 4351 TACOMA, WASHINGTON 98438
FRIENDSHIP THROUGH AIRLIFT
Rev: 04/11/2008