WINDY CITY SOARING ASSOCIATION, Inc

APPLICATION FOR FAMILY MEMBERSHIP

WCSA MISSION: The mission of Windy City Soaring Association (“Association” or “WCSA”) is to advance and promote the art, science, and sport of soaring through a complete program of education, training, and advanced flying for the benefit of its members and the general public.

ELIGIBILITY: Any person interested in soaring and who wishes to participate in the achievement of our mission may apply for membership in WCSA. Membership categories include Regular, Family, Youth and Associate. All applications for WCSA membership will be reviewed by the Board of Directors for final approval.

Date of application ______Name: ______Date of Birth: ______Home address: ______Home Phone: ______(City/State) (Zip) ______Mobile Phone: ______E-mail ______Work Phone: ______

IN CASE OF INJURY PLEASE NOTIFY (must be 18 years or older): Emergency Contact ______Phone: ______Address: ______(Street) (City) (State) (Zip Code)

Are you a member of the Soaring Society of America? YES/NO Member ID: ______(SSA Membership will be charged to your account annually and paid by the club)

FLYING EXPERIENCE AND RATINGS: Pilot Certificate # ______Ratings: ______Flight Review Date ______Total Glider PIC Hours ______Last 12 Months ______Last 90 Days ______Total Power PIC Hours ______Last 12 Months ______Last 90 Days ______Glider Aircraft Flown: ______SSA/ FAI Badges or legs of badges held: ______Power Aircraft Flown: ______Do you currently own an aircraft that you intend to base and fly at the field? ______Have you ever been the pilot in command of an aircraft involved in an accident YES/NO

WCSA Family Membership Application (2015).docx CONFIDENTIAL WHEN COMPLETE Page 1 of 4 DECLARATION

I DECLARE that I have been provided a copy of the current Windy City Soaring Association, Inc. Membership Terms and Conditions and I agree to abide by the obligations and agreements laid-out therein. I acknowledge and agree that such document is incorporated by reference into this membership application and may be updated from time-to-time by the Association and that I am solely responsible to remain current and in compliance with any changes.

I CERTIFY that the statements contained in this membership application are true and accurate and that I have read and fully understand all aspects of my application for Membership.

Agreeing to all of the above I hereby apply for membership in the Windy City Soaring Association, Inc., this

______day of ______, 20__. Applicant Signature:______

Applicant Sponsors: All applicants must have a sponsor. A sponsor is a member of the Board of Directors of the club who is knowledgeable of club procedures and is willing to provide any guidance the new member may require until familiar with club procedures.

WCSA Sponsor: ______

IF APPLICANT IS UNDER THE AGE OF 18: Inasmuch as the applicant is under the age of 18, I hereby give my consent for him/her to join Windy City Soaring Association, Inc., and agree to assume full financial responsibility for the payment of all dues, fees, flight charges and/or other liabilities and obligations which she/he incurs. I also agree to release and forever discharge the "Released Parties", acting officially or otherwise, from any and all claims, demands, actions or causes of action resulting in the applicant death or resulting in any injury to her or his property which may occur from any cause during said flight or flight activity or continuance thereof, as well as during all ground and flight operations instant thereto.

Legal Guardian: ______Relationship: ______Date:______Name:______Phone# ______

WCSA Family Membership Application (2015).docx CONFIDENTIAL WHEN COMPLETE Page 2 of 4 Recurring Credit/Debit Card Payment Authorization Form

I, , agree that any charges I incur using the resources of Windy City Soaring Association are due when posted to my account. Charges may include monthly membership dues, fees WCSA pays on my behalf, special events (such as awards dinner), flight and aircraft rental charges, hanger rent, field usage fees and other items that may arise from time to time. Detailed statements will be emailed to me on a monthly basis during the first week of the following month and I expressly agree that any outstanding balance will be posted immediately to the credit card or debit card account described below. I will have until the next statement cycle to review the charges for any errors or omissions and request an adjustment to my account in the form of a credit to my WCSA account. If I do not report any errors by the next payment cycle, then all charges will be considered correct and final. In the event my financial institution declines to authorize the charges to my credit/debit card, I will be notified by WCSA via email and I will have 7 days to provide an alternate credit card/debit card number. Should WCSA incur any bank charges or fees arising from a declined credit authorization or insufficient funds in my bank account, I agree to reimburse WCSA for those costs.

□ Credit Card Information □ Debit Card Information <- (Select One)

Card Type: □ MasterCard □ Visa □ Discover

Card Holder Name: ______

Card Number: ______Exp: ______/_____

Billing Address: ______

Membership Dues Election Form

I, , elect to pay my membership dues as follows:

□ Monthly $16.50 (due 1st day of the month) □ Quarterly $43.50 (due 1st day of Jan, Apr, July, Oct) □ Annually $170.00 (pro-rated to January 1 annual renewal)

I understand that membership dues are paid in advance and that failure to maintain my account in good standing may result in suspension of club privileges or termination of my membership.

This payment authorization will take effect on ______, 20___ and authorizes WCSA to post charges to my designated credit/debit card account for the full amount of my prior month’s WCSA Statement when it becomes due. This authorization will remain in full force and effect until I, , notify Windy City Soaring of its cancellation by sending written notice in such time and in such manner to allow both the WCSA and receiving financial institution a reasonable opportunity to act on it. Cancellation of this payment authorization does not relieve me from any payment obligation arising from any amount owed or due to WCSA.

Member Signature: ______Date: ______

Guardian’s Signature: ______Date: ______(if member is under 18 years of age)

WCSA Family Membership Application (2015).docx CONFIDENTIAL WHEN COMPLETE Page 3 of 4 DIRECT BANK DEBIT (ACH) PAYMENT AUTHORIZATION

I, , agree that any charges I incur using the resources of Windy City Soaring Association are due when posted to my account. Charges may include monthly membership dues, fees WCSA pays on my behalf, special events (such as awards dinner), flight and aircraft rental charges, hanger rent, field usage fees and other items that may arise from time to time. Detailed statements will be emailed to me on a monthly basis during the first week of the following month and I expressly agree and authorize Windy City Soaring Association to immediately initiate either an electronic debit or to create and process a demand draft against the bank account information described below for any outstanding balance on my WCSA account. I will have until the next statement cycle to review the charges for any errors or omissions and request an adjustment to my account in the form of a credit to my WCSA account. If I do not report any errors by the next payment cycle, then all charges will be considered correct and final. In the event my financial institution declines to authorize the charges to my bank account, I will be notified by WCSA via email and I will have 7 days to provide an alternate credit card/debit card number. Should WCSA incur any bank charges or fees arising from a declined credit authorization or insufficient funds in my bank account, I agree to reimburse WCSA for those costs.

I understand and acknowledge that the origination of ACH transactions by WCSA to my account will comply with the provisioning of United States law.

Bank Information (attach voided check)

Bank Name: ______Routing (ABA) Number: ______

Bank Account Number: ______Account Type (circle): Checking / Savings

Membership Dues Election Form

I, , elect to pay my membership dues as follows:

□ Monthly $16.50 (due 1st day of the month) □ Quarterly $43.50 (due 1st day of Jan, Apr, July, Oct) □ Annually $170.00 (pro-rated to January 1 annual renewal)

I understand that membership dues are paid in advance and that failure to maintain my account in good standing may result in suspension of club privileges or termination of my membership.

This payment authorization will take effect on ______, 20___ and authorizes WCSA to process ACH billings to my designated bank account for the full amount of my prior month’s WCSA Statement when it becomes due. This authorization will remain in full force and effect until I, , notify Windy City Soaring of its cancellation by sending written notice in such time and in such manner to allow both the WCSA and receiving financial institution a reasonable opportunity to act on it. Cancellation of this payment authorization does not relieve me from any payment obligation arising from any amount owed or due to WCSA.

Member Signature: ______Date: ______

Guardian’s Signature: ______Date: ______(If member is under 18 years of age)

WCSA Family Membership Application (2015).docx CONFIDENTIAL WHEN COMPLETE Page 4 of 4