Bellanca-Champion Club

Membership Application                        
Click here for Online Membership Page
Please print and mail to: Dues:     U.S. Dual * Foreign Dual *
    Bellanca-Champion Club           (incl. Canada)
    PO Box 100 1 year       $38 $63   US$43   US$68
    Coxsackie NY 12051 2 years     $72 $122   US$81   US$131
3 years     $108 $183   US$122   US$197
* Dual - Concurrent membership in the Aeronca Aviators Club (a $32 value) is only $25 per year.

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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