Pay by check – Kansas Pilots Association

First Name *

Middle Name

Last Name *

Spouse First Name (if needed)

Street Address *

Street Address 2 (if needed)

City *

State (Choose from dropdown) *

Zip Code (5 digits) *

Email (Primary) *

Email Address (Secondary)

Phone (Home) *

Phone (Cell)

Home Airport Identifier (DO NOT include "K" prefix)

Are you a Pilot?

Are You Instrument rated?

Instrument rated

Cat/Class

CFI

CFI Ratings

SEL

MEL

SES

New Option

Mechanic License

Airframe

Powerplant

Airframe Inspector

Agreement *

I understand that to join I must mail my membership dues of $25/year to: KPA Treasurer 9811 S 183rd W Clearwater, KS 67026

Certification *

I certify that the information provided is correct to the best of my knowledge, and I am submitting my application for memebership.

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