Please read, sign, and send the liability release form to, then complete the form below. Our membership chairman will follow up with you promptly.

Name *
Address *
Is your address registered with the FAA? *
If not, do it immediately
Date of Birth *
Date of Birth
Home Phone *
Home Phone
Work Phone
Work Phone
Mobile Phone
Mobile Phone
Next of Kin *
Next of Kin
Address of Next of Kin *
Address of Next of Kin
First glider flight *
First glider flight
Last biennial flight review date *
Last biennial flight review date
Launch Type Qualifications
Accident History
If any of the following are yes, a detailed explanation is required.
Have you had an accident while PIC? *
Have you ever been cited for violation of FAA or Military Aviation Regulations? *
Are you flying subject to any limitations, waivers, or restrictions? *
Have you ever had an application for aircraft insurance declined? *
Date, location, make & model of aircraft, and cause
Flight History
I have CFI-G signoffs in my logbook for the following
By checking "Agree," I certify that I will fly only those BASA aircraft for which I have a CFI-G signoff and flight committee approval *
By checking "Agree" and submitting this application, I certify that all information provided by me on this application is true and verifiable by independent documentation or the FAA. *