<p> Southwest Flying Club, Inc – Houston, Texas Application for Membership Applicant: Name: Date of Birth: Drivers License:</p><p>Mailing Address: City: State: Zip:</p><p>Employer: Employer Address:</p><p>Home Phone: Office Phone: Email:</p><p>Cell Phone: Alternate Email: Last BFR: Last Physical: Phys. Class:</p><p>Pilots Cert. No.: Cert. Type: Ratings: Nationality: Total Hours:</p><p>Dual: Solo: C182: G1000 (Cessna): G1000 (other):</p><p>Spouse: Name: Date of Birth: Drivers License:</p><p>Employer: Employer Address:</p><p>Office Phone: Email:</p><p>(If spouse also a pilot): Pilots Cert. No.: Cert. Type: Ratings: Last BFR: Last Physical: Phys. Class:</p><p>Total Hours: Dual: Solo: C182: G1000:</p><p>Have you or your spouse ever been involved in an aircraft accident or incident? (If yes, please explain on back of form or on separate page.) In Case of Emergency, Notify: Name: Address: Phone:</p><p>References: Bank: Address: Phone:</p><p>Credit: Address: Phone:</p><p>Credit: Address: Phone:</p><p>Personal: Address: Phone:</p><p>Personal: Address: Phone:</p><p>Applicant’s Signature: I have read the Aircraft Operation Rules and Bylaws of the Southwest Flying Club, Inc. and agree to abide by and accept pilot responsibility as described in these documents. Signature: Date: </p><p>SEND NO MONEY NOW. Return completed form to: [email protected] Carolyn Strempel 6910 Kelsey Rae Court, Houston, TX 77069</p><p>Rev. 3/15 E Bauer</p>