Online Membership Application

Grey Eagle New Member Application Only! — ATTENTION: DO NOT USE THIS FORM FOR ANY REASON IF YOU ARE ALREADY A GREY EAGLE!!

Dues Options:

1. $500 – Regular Membership, paid in full
2. $300 – Initial payment plus $100/year for the next 2 years
3. $100 – Regular Membership (Pilots over the age of 80 applying for the first time
4. $100 – Auxiliary Membership for surviving spouse of a non-Grey Eagle member

*Note: You will be invoiced by the Treasurer. Check is preferred but cc via Paypal is optional (5% convenience fee is charged).

Applications are not fully processed until payment is received.

First Name:* First Name Required

Last Name:* Last Name Required

Employee # (6-Digit) (If Auxiliary, spouses employee # preceded by S-):* Employee # (6-Digit) (If Auxiliary, spouses employee # preceded by S-) is Required

Prefix (e.g Dr.,Mr.,Mrs.,Ms.): Prefix (e.g Dr.,Mr.,Mrs.,Ms.) is not valid

Middle Name: Middle Name is not valid

Suffix (e.g. Jr.,II): Suffix (e.g. Jr.,II) is not valid

Spouse or S/O Name: Spouse or S/O Name is not valid

Street Address:* Street Address is Required

City:* City is Required

State (2 Letter Abbreviation):* State (2 Letter Abbreviation) is Required

Zip Code (9 Digit if possible):* Zip Code (9 Digit if possible) is Required

Telephone # (xxx-xxx-xxxx format): Telephone # (xxx-xxx-xxxx format) is not valid

Cell Phone # (xxx-xxx-xxxx format): Cell Phone # (xxx-xxx-xxxx format) is not valid

Alternate / International Phone: Alternate / International Phone is not valid

Email:* Email is Required

Spouse or S/O Email: Spouse or S/O Email is not valid

2nd Street Address: 2nd Street Address is not valid

2nd City: 2nd City is not valid

2nd State ( 2 Letter Abbreviation) : 2nd State ( 2 Letter Abbreviation) is not valid

2nd Zip Code ( 9 Digits if possible): 2nd Zip Code ( 9 Digits if possible) is not valid

Dates for 2nd Address: Dates for 2nd Address is not valid

Date of Birth (mm/dd/yyyy): Date of Birth (mm/dd/yyyy) is not valid

Date of Hire ( AA or name of airline that merged with AA)(mm/dd/yyyy): Date of Hire ( AA or name of airline that merged with AA)(mm/dd/yyyy) is not valid

Retirement Date (if already retired) (mm/dd/yyyy): Retirement Date (if already retired) (mm/dd/yyyy) is not valid

Retirement Category (e.g Normal Age-65, Early,Medical): Retirement Category (e.g Normal Age-65, Early,Medical) is not valid

Last/Current Base: Last/Current Base is not valid

Employee Number:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

*

 

No val Please fix the errors above