DATE _______________

NAME_________________________________________________________________

ADDRESS______________________________________________________________

CITY___________________________________STATE____________ZIP__________

HOME PHONE (___ )________________WORK PHONE (___)__________________

E-MAIL ADDRESS______________________________________________________

BASE_____________________UNIT____________

COMPANY____________________________________________

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AIRCRAFT FLOWN___________________________________________________

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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