CCAA 2006 MEMBERSHIP RENEWAL FORM

Name:    ____________________________________________   Home Phone: _____________

Address: ____________________________________________   Cell Phone: _____________

City: _______________________ State: _____ Zip Code: _________

Email: ___________________________________________

2006 Membership Class:

[___] Active Membership for holders of an FAA Pilot or Mechanic
      certificate: $12.00/year

[___] Family Membership for holders of an FAA Pilot or Mechanic
      certificate & Spouse: $18.00/yr

      Name of Spouse: ________________________________________

[___] Associate Membership for non-certificated holders who are
      affiliated with aviation through aircraft ownership, business
      or government employment:  $12.00/year.

I have enclosed $________ dues for my 2006 membership.

Signature:______________________________________  Date:__________

[___] I would be interested in serving on a CCAA Committee.

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(Official Use Only)

Paid: Check [___]  Cash [___]

Received By: ________________ Date: __________

Posted Roster: ______________ Membership Card Issued: _____________