Kadena Aero Club - Membership Preparation Checklist
NAME: _______________________________________________________________
I.

***The following items must be completed prior to scheduling instruction. ****Date ________ AF Form 1710, Membership Application*Date ________ AF Form 1585, Covenant Not to Sue*Date ________ Membership Agreement (member keeps copied documents for future reference)*Date ________ Copy of valid Military ID (remind members to bring in new ID when current one expires)**Date ________ Copy of FAA Pilot Certificate (if applicable)**Date ________ Copy of Medical Certificate/ Student Pilot Certificate (if applicable)o Initial and Date: _____________________
Note 1: Obtaining an FAA medical certificate is the responsibility of the student
or member and must be obtained prior to the student’s first supervised solo flightor prior to the first flight for any rated pilot. At Kadena it can take up to 6 months
or more to get an appointment for a flight physical.
Note 2: If you think that you have a physical discrepancy, it is highly
recommended that you contact an FAA doctor before taking a flight lesson.
*Date ________ Initiation Fee and First Month’s Dues  $35.00 + $25.00 = $60.00*Date ________ Create Aero Club Dispatch Program Account/Membership ID*Date ________ Create Online Schedule Program Account (FlightSchedulePro)*Date ________ Membership CardII.

*** The following items are mandatory for Pvt/Ins/Com training. ***Date ________ Original Birth Certificate, US Passport, or Naturalization as proof of US
citizenship. (Otherwise, student must proceed through TSA AFSP.)
Date ________ Logbook endorsement as proof of US citizenship from an instructor.
Date ________ Memorandum from Chief Instructor

III.

*** The following must be accomplished prior to your first flight. ***Date ________ Standardization and Make & Model exams (mandatory for Rated Pilot)
Date ________ PIFs (Pilot Information Files)
Date ________ Attend Safety Meeting or watch Safety Meeting video
Date ________ Local area familiarization slides
Date ________ Standard Operating Procedures (SOP)
Date ________ Receive Instructor Assignment from Chief CFI, if students.
(If not, contact Aero Club staff to receive checkout instructor.)
Name of Primary Instructor: __________________________________
Date ________ Contact Instructor to set up 3 hours ground instruction for grading tests(for rated pilots) and indoctrination briefing (ALL members).
o Date/Time/Who Scheduled: _______________________________________
Date ________ Indoctrination Briefing

Please return this form with the Indoctrination Form to the Aero Club Staff prior to your first flight.

Signature: ________________________________________ Date: ___________________________DATE

KADENAMEMBERSHIP APPLICATIONAFB AERO CLUBAUTHORITY; 10 USC 8012, Secretary of the Air Force: powers and duties; delegation by.
PRINCIPAL PURPOSE(S): To determine individual's eligibility for aero club membership and past flying experience.
ROUTINE USES: To determine an individual's eligibility for membership and flying activities In an Air Force aero club and provide the club informationon the individual's history and capabilities as a pilot. Information maybe disclosed to the Federal Aviation Agency, National Transportation Safety Board,and Veteran's Administration personnel conducting official business and having a valid requirement for the information. Information may also be disclosed
to any DOD component or part thereof, and upon request, to other Federal, state, and local governmental agencies in the pursuit of their official duties.
It may also be disclosed to commercial insurance carriers in-instances where incidents potentially impact on aero club insurance coverage. Finally, it may
be used for other lawful purposes including law enforcement and or litigation. SSAN is used for positive identification of the individual and records.
DISCLOSURE IS VOLUNTARY: Failure to provide any or all of the information, including SSN, may result in the individual being denied aero clubmembership and or participation in aero club flying activities.
(Last 6 digits)

NAME (Last, First, Middle Initial)

GRADE

SSN

MAILING ADDRESS (Number, Street, City, State, Zip Code)HOME PHONEDATE OF BIRTH

IDENTIFICATION CARDNO.
N/ADATE SEPARATED FROMACTIVE DUTY
N/A

DUTY ADDRESSDUTY PHONE

TYPE OF MEMBERSHIPX REGULAR

BASIS OF ELIGIBILITY
ACTIVE RETIREDRETIRED MILITARY
CIVILIAN

DEPENDENT DOD/NAF

INTRODUCTORYRESERVEOTHER (Specify)

DATA FOR EMERGENCY NOTIFICATIONADDRESS (Number, Street, City, State, Zip Code)NAME (Last, First, Middle Initial)

PHONE/AREA CODE

RELATIONSHIPSPONSOR INFORMATION (Complete if Dependent)
TYPE OR PRINT SPONSOR'S NAME (Last, First, Middle Initial)

SPONSOR'S SIGNATURE (Only Required for Minors)

DATE

ORGANIZATIONGRADERELATIONSHIPSSN

RESERVE/NATIONAL GUARD PERSONNEL
OFFICIAL ORDERS STATING CURRENT RESERVE/NATIONAL GUARD STATUS ARE ATTACHED.
I understand that should my Reserve or Guard status change and make me ineligible for aero club membership, it is my responsibility to notify the aero clubmanager and terminate my membership.
SIGNATURE

TYPE OR PRINT NAME (Last, First, Middle Initial)

DATE

PILOT CERTIFICATION INFORMATIONFAA CERTIFICATEATP
RATING:CERTIFICATE(S) NO.

COMMERCIALSELPRIVATEMEL

CFISTUDENTCF II
TOTAL HOURS FLYING TIMEINSTOTHER (Specify)
DATE LAST BFR

GSM
NONE
TOTAL HOURS FLOWN LAST 12
MONTHSFCC PERMIT GRANT DATEFAA MEDICAL CERTIFICATEDATE OF PHYSICAL
CLASS

PLEASE ANSWER THE FOLLOWING QUESTIONS. HAVE YOU EVER BEEN:

YES

A. A member of a U.S. Armed Forces Aero Club?
B. Denied membership in or terminated from a U.S. Armed Forces Aero Club?
C. Refused an aeronautical certificate or had an aeronautical certificate suspended or revoked?
D. Reported for violation of any FAA regulation or other flying regulations?
E. Involved in an aircraft incident/accident?
F. Convicted of use of hallucinogens or dangerous drugs including marijuana?
G. Convicted of serious alcohol-related charges such as operating motor vehicle under influence of liquor?
If answered yes, give full details, including date, location, nature, and disposition, on separate sheet and attach)
CERTIFICATION (To be completed by civilian applicants, including dependents)
I certify that the above information is true and correct. I further certify that if accepted for membership I will read and comply with ail Air Force, FAA,
State, and AERO Club Directives and that I am financially able to pay any forseeable financial obligations incurred through this membership. In considerKadena
ation of the
Aero Club accepting payment by check for goods or services and for payment by charge/credit formyself and my authorized dependents, I hereby authorize deductions from my pay for any check given by me or my authorized dependents that is subsequently dishonored and for any charge/credit sale which is not paid within 90 days of when I am notified the charges are due. I understand that
violation of any regulation may be grounds for suspending or revoking my membership and may make me liable for any damages to persons or property
as a result of such violation. Furthermore, I will terminate my membership in writing and will settle my account prior to departure.
APPLICANT'S SIGNATURESPONSOR'S SIGNATURE (Required for Minor Dependents)

LETTER OF GOOD STANDING
YESMEMBERSHIP CARD NO.

FOR OFFICE USE ONLYMANAGER'S SIGNATURE

NO

AF Form 1710, OCT 86 (V1)

PREVIOUS EDITION IS OBSOLETE.

DATE

NO

AGREEMENT
1. The undersigned, in consideration of the rental to him/her from time to time of aircraft understand and agree
to the terms and conditions of this agreement: (please initial before each statement)
a. _____ I agree to comply with all applicable directives and operate club aircraft in a safe and prudent
manner consistent with Air Force, FAA, and the aircraft manufacturer’s guidance. (NOTE: Operations
that damage aircraft can lead to assessment of pecuniary liability under AFI 34-402, Protecting
Nonappropriated Fund Assets. Examples of culpable negligence include: Failure to follow checklist
procedures, disregarding operating restrictions, flying while out of currency, and careless or reckless
operation of aircraft.)b. _____ I agree to immediately notify the Aero Club of any change in personal information if this change
has any bearing upon my ability or qualifications to operate an aircraft or the Aero Club’s ability tocontact me by telephone/email or mail.
c. _____ I agree to pay monthly dues on the 3rd day of the month, unless I am TDY for full number of daysof the month and unable to visit another military club to fly. I agree that, should I fail to pay
membership dues as required for a period of ninety (90) days, I will be considered in a delinquent status
regarding club dues. If I am in a delinquent status, and have not submitted a valid resignation form,
IAW Kadena Aero Club SOP, Chapter 1, I agree that the Nonappropriated Funds Accounting Office(NAFAO) may initiate a Military Pay Order Action via DD Form 139 and collect any delinquent debts
outstanding. Thereafter, I understand that I may be terminated from club membership if I continue to bedelinquent in paying my club dues/invoices, IAW Kadena Aero Club SOP.
d. _____ I agree to assist the manager or other club officials in daily club operations when requested.
e. _____ I agree to present my logbooks, pilot certificate, and medical certificate to the manager, chief
flight instructor, or clearing authority for examination upon request.
f.

_____ I agree to attend scheduled monthly safety meetings. I agree to notify the Aero Club if I am
unable to attend the safety meeting in advance with a valid reason.

g. _____ I agree that once I have received ground or flight training; there will be no refund, regardless ofmy progress in the overall training of my pilot training.
h. _____ I understand that I would need to request my aero club account balance and refund, if applicable.
I agree that there will be no refund 60 days after termination.
2. The Aero Club will furnish the member, at prevailing rates, suitable aircraft to meet recreational flying,currency requirements and proficiency and standardization check flights required by applicable directives.

_______________________________ ____________________________ _____________________
Member’s Name
Member’s Signature
Date
I hereby give authorization for all Aero Club transactions to be charged to my Visa/MC/AMEX account. (circle one)_________________________ _______________________________________ _____/_____ CVV# ______
Member’s Signature
Credit Card #Exp. DateATTACHMENT 1

Credit Card Recurring Payment Authorization Form
Schedule your payments to be automatically charged to your credit card. Just complete and sign this form to getstartedI
Recurring Payments WIii Make Your Life Easler:••

It's convenient (saving you time and postage)
Your payment is always on time (even If you're out of town), ellmlnatlng late charges

Here's How Recurring Payments Work:

You authorize regularly scheduled charges to your Visa, or MasterCard. You will be charged each bllllng period for the
total amount due for that period. A receipt wlll be emailed to you and the charge wlll appear on your credit card
statement. You agree that no prior-notification will be provided If the total payment Is under the amount authorized
below. If your bill is more than that amount, or the payment date changes, you will receive notice from us at least 10
days prior to the payment being collected.

Please complete the Information below:

I ________________________________authorize Kadena Aero Club
indicated(full name) below on:

to charge my credit card

The third of each month for payment of my _D_ue_s _ In the amount of _ _25_ .0_0 _ _ _ _The 1st and 15111 of each month for payment of my ___________ in the amount of _____________
The first Monday of each week for payment of my ___________ In the amount of $_I understand that I will only receive advance notice of the charge If It exceeds an amount different than authorized .
Phone_# __________________________

Billing Address
City, State, Zip

Account Type:____________________________

Visa

MasterCard

Email

American Express

Cardholder Name
Card Number
Expiration Date

CVV (3 digit number on back of Visa/MC)

SIGNATURE _______________________________________________

_____
DATE

Iauthorfze the above named business to charge the credit card Indicated In this authorfzatlon form according to the terms outlined above. If the above
noted payment dates fall on a weekend or holiday, I understand that the payments may be exea.tted on the next business day. I understand that thisauthorfzatlon will remain In effect untll I cancel It In writing, and I agree to notlfy the business In wrttlng of any changes In my account lnformatlon or
termination of this authorization at least 15 days plior to the next bllllng date. This payment authorization Is for the type of blll Indicated above. I certifythat I am an authorized user of this credit card and that I will not dlsput,e the scheduled payments with my credit card company provided the transactlons
correspond to the terms Indicated In this authorization form.