Bellanca-Champion Club

Membership Application

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Please print and mail to:	Dues:	U.S.	Dual *	International	Dual *
Bellanca-Champion Club				^{(incl. Canada)}
*277 Mansion Street*	*1 year*	*$44*	*$79*	*US$47*	*US$82*
*Coxsackie NY 12051*	*2 years*	*$83*	*$153*	*US$89*	*US$159*
	*3 years*	*$125*	*$230*	*US$134*	*US$239*
* Dual - Concurrent membership in the *Aeronca Aviators Club* (a $39 value) is only $35 per year.
New Members: Name and full address required for mailing credentials and magazine
Name: ________________________________ Spouse: ________________
Address: ______________________________________________________
_______________________________________________________
City, State: ________________________________ Zip: ______________
Tel (Home): _______________________ (Work): ______________________
E-mail Address: __________________________________________________
Comments: ______________________________________________________
______________________________________________________
_{Do you own an aircraft? I'm lucky! I own two:}
Year: ______ Model: ___________ Year: _____ Model: __________
Registration: (N) _______________ Registration: (N) ______________
^{Please make check payable to: Bellanca-Champion Club ....Welcome to the Club....}
Member Contact Information Privacy Policy: There is a need for members to contact each other for model-specific issues from time to time. To assure your right to privacy, we are implementing an "opt-in" program. To be available to other members, please check below: I agree to allow the Bellanca-Champion Club to release the information checked below to current Club members: Home Telephone Number (as listed above) or special number: (_____) _____________________ Work Telephone Number (as listed above) or special number: (_____) _____________________ Email Address (as listed above) or special address: ____________________________________

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