Name   First: M.I.: Last: Jr/Sr: Nickname:
Address:
City:   State:      Zip:
Home Phone:    Work:    Cell:
E-mail address:
Personal Data    Male:   Female:    Age:     Date of Birth: mm/dd/yyyy
License Data   Ratings:    Date Last BFR: mm/dd/yyyy
                        Pilot Certificate #:
Flight Hours   Total Time:     Night Time:    Time last 6 months:
                      Aircraft Types:
Medical    None:   Class: 3rd   2nd:   1st :     Date of Exam: Expires: mm/dd/yyyy
                Restrictions:

In Case of Emergency:
     Contact First Name: Last Name:   Relation to You:  
     Home Phone:    Cell Phone:
     Address: 
     City:     State:     Zip: 

TEXINS Eligibility
Company:    Emp./Retiree Name: 
TIer’s Data   Employee #:    Division:    Cost Center:    Mail Station:    PC Drop:
Application is for:  Employee:      Retiree:       Spouse:        Dependent:        Other:

I hereby certify that all the information on this membership form is true to the best of my knowledge.  I understand that any falsification shall be grounds for disqualification or forfeiture of my membership.  I have received, read, understand, and agree to abide by the Texins Flying Club (the “Club”) Constitution, Bylaws, Flying Regulations, Operating Regulations and Financial Agreement.  In particular, I acknowledge that I have read and agree to be bound by Article VI Section 2 of the Bylaws, which states that I shall be responsible for any damages or abuse to an aircraft that I am using.  I also acknowledge that I shall not seek to hold Texins Flying Club legally responsible for my acts while operating a Club aircraft which results in damages, injuries or death, whether to myself or others.  I further acknowledge that I have read and agree to be bound by Article I of the Bylaws, which provides that I shall be fiscally responsible for my dues, timely flight payments and any collection fees.

I also agree and understand that:

Initials

I will not allow non-members, whether pilots or not, to operate Texins Flying Cub Aircraft because they are not insured through the Texins Flying Club.  All flight instructors instructing in Club Aircraft must be members of the Texins Flying Club, and be authorized by the Club’s Chief Flight Instructor.

I will not operate Club Aircraft if not in compliance with all  FAA regulations and if my TFC Annual Flight Review is not current.

I will not operate Club Aircraft for hire, either under Part 91 or Part 135 of the FAR’s

I, alone, am personally and financially liable and responsible if I participate in any uninsured operations of Club Aircraft.

I will maintain and promptly notify the Club of any changes to my telephone numbers, billing address, email, and credit/debit card(s) information by updating this information myself using the Texins Flying Club website.

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