APPLICATION TO JOIN AIR SAFETY AUSTRALIA

Print this application form, complete it, and fax it to AIR SAFETY AUSTRALIA on 08 8276 4666. Alternatively (but only if you are able to apply your signature electronically) you can e-mail it to admin@airsafety.com.au

I hereby apply to join AIR SAFETY AUSTRALIA.

SIGNED:_________________________________________DATE_______________________

PRINT FULL NAME:___________________________________________________________

ADDRESS:___________________________________________________________________

___________________________________________________________________________

PHONE:_____________________________________________________________________

FAX:_______________________________________________________________________

E-MAIL:____________________________________________________________________

MOBILE:____________________________________________________________________

OCCUPATION:________________________________________________________________
PILOT LICENSE: PRIVATE / AUF / STUDENT / CPL / ATPL / INSTR / OTHER / NIL

If you own an aircraft - CALL-SIGN__________________TYPE___________________

REMARKS:___________________________________________________________________

___________________________________________________________________________
Now fax this to 08 8276 4666 or e-mail it (signed) to admin@airsafety.com.au