Bellanca-Champion ClubMembership 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 | $60 | US$43 | US$65 | |
| Coxsackie NY 12051 | 2 years | $72 | $116 | US$81 | US$125 | |
| 3 years | $108 | $174 | US$122 | US$188 | ||
| * Dual - Concurrent membership in the Aeronca Aviators Club (a $29 value) is only $22 per year. | ||||||
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Name: ________________________________ Spouse: ________________ |
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Address: ______________________________________________________ |
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City, State: ________________________________ Zip: ______________ |
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Tel (Home): _______________________ (Work): ______________________ |
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E-mail Address: __________________________________________________ |
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Comments: ______________________________________________________ |
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______________________________________________________ |
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| Do you own an aircraft? I'm lucky! I own two: | ||||||
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Year: ______ Model: ___________ Year: _____ Model: __________ |
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Registration: (N) _______________ Registration: (N) ______________ |
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Please make check payable to: Bellanca-Champion Club ....Welcome to the Club.... |
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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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