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!! Membership Fee Options:

1. Regular Membership, paid in full – $500
2. Regular Membership, initial payment $300, and then $100/year for the next 2 years
3. Regular Membership (Pilots over the age of 80 applying for the first time) – $100
4. Auxiliary Membership for the surviving spouse of a person who would have qualified for Grey Eagle membership – $100
5. If you are on Long Term Disability (LTD), please contact the Treasurer, Steve Browning, at treasurer@thegreyeagles.org for fee information.

*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. Submitted Information Note: All the information you provide is for The Grey Eagles organization only and will not be provided to any outside third party without your written consent. The Grey Eagles members will have Member Lookup information only, and that information can be further restricted by you on your Account page.

First Name:* First Name Required

Last Name:* Last Name Required

Middle Name: Middle Name is not valid

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

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

Employee # (6-Digit) :* Employee # (6-Digit) is Required

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

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

Spouse MiddleName: Spouse MiddleName is not valid

Spouse NickName: Spouse NickName is not valid

Spouse Date of Birth: Spouse Date of Birth 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

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

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

Spouse CellPhone: Spouse CellPhone is not valid

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

Date of Hire (used by AA) (mm/dd/yyyy): Date of Hire (used by 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

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

Employee Number:* Invalid Username

Email:* Invalid Email

*

 

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