TIC170A Membership Application (You don't have to be an airplane owner to join)

Fill in as much information as you can (even if you are only renewing).  The required fields are underlined.
Follow one of the three procedures listed below, depending on your payment method. Please allow 1-2 weeks for processing. Please select the payment method before you print or send the form.
Call HQ at 307-587-6397 with questions or Credit Card info.

Print this page and mail it with a check for $45 ($130 for 3 yrs)(US Funds) payable to:

 

 

The International Cessna 170 Association
22 Vista View Lane
Cody, WY 82414-9606

Print this page, fill in the Credit Card (VISA or M/C only) info below, and mail it to the above address or fax it to 307-587-4297.

Pay via PayPal.  The form contents (with exception of Credit Card info) are sent to headquarters by email when you click the "Pay via PayPal" button at the bottom of the page.  You will then be directed to the PayPal site for payment.  This is the easiest, and preferred, method. Do NOT fill in the Credit Card info on this form if paying by PayPal.

$45 - 1 yr or $130 - 3 yrs
New Member or Renewal (Member No. ) If you have not been a member for more than 6 months, please select New.
First Name:
Last Name:
Address1:
Address2:
City:
State/Province:
Zip/Postal:
Country:
Phone (123-456-7890):
Fax (123-456-7890):
Email:
Age: Married Single
Spouse's Name:
Children's Ages:
Date of Application:
Occupation:
Year you started flying:
Military flying experience:

Aircraft:
Mfr: Model:
Year:
Reg #: S/N:
TTAF: TTE: SMOH:
Eng type & HP:
Prop:

For Credit Cards only, complete and mail, phone or fax the following:

Type:
Number:
Expires:
Name on Acct:
Signature:

Are you interested in providing hospitality for members visiting in your area? Yes No
How did you learn about TIC170A?
Dues include subscription to THE 170 NEWS, a quarterly magazine.
Check here if magazine is NOT wanted