Viewing page 91 of 93

This transcription has been completed. Contact us with corrections.

APPLICATION FOR MEMBERSHIP APPLICATION FOR MEMBERSHIP

REPA
E. Neal  Holland, Editor
3491 Pall Mall Drive, Suite 201-B
Jacksonville, FL 32257

TITLE (Capt. Mr. or Mrs.).    
Date
NAME (last, first middle)
ADDRESS 
CITY STATE
Zip

TELEPHONE NUMBER, AREA CODE ( ) 

NAME CALLED BY
SPOUSE'S NAME 
YOUR DATE OF BIRTH 
PLACE OF BIRTH

DATES EMPLOYED BY EASTERN AIR LINES (from) (to)
WAS SPOUSE AN EASTERN EMPLOYEE?

ARE YOU A RETIRED PILOT
DATE OF RETIREMENT 

ARE YOU APPLYING FOR AFFILIATE MEMBERSHIP IN REPA
WHEN AND WHERE DID YOU LEARN TO FLY?   
WHAT WAS YOUR CIVILIAN AND/OR MILITARY FLYING EXPERIENCE

EASTERN EXPERIENCE

PLEASE INCLUDE CHECK FOR $25.00                    
SIGNATURE
Subsequent annual dues are $25.00, payable on your birthday.  Affiliate dues are
payable on January 1st of each year. Please send dues to the Secretary at the above
address. Widows are exempt from dues.

Transcription Notes:
removed all lines and indents