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U. S. ARMY BLACK AVIATION ASSOCIATION, Inc.
MEMBERSHIP APPLICATION
PURPOSE
1. To establish communications between former and current Army Aviation personnel.
2. To identify the contributions that Black Army Aviation personnel have made to these United States, in both the military and civilian communities.
3. To encourage young Blacks and other minorities to consider the field of Army Aviation as a career.
4. To stimulate and encourage employment opportunities for Blacks and other minorities in all areas of aviation.
APPLICANT
NAME_______________________________________________________________ RANK_________
STATUS ______________________ (Active, retired, etc.) SPOUSE____________________________
STREET ADDRESS____________________________________________________________________
CITY_______________________________________________STATE________ZIP________________
Work Phone________________ Home Phone________________ Email__________________________
PERMANENT ADDRESS
STREET ADDRESS____________________________________________________________________
CITY_______________________________________________STATE________ZIP________________
AIRCRAFT/AVIATION FIELDS AND/OR RATINGS __________________________________________
CURRENTLY FLYING____________ IF YES, AIRCRAFT TYPES________________________________
CURRENT OCCUPATION_______________________________________________________________
Check One: National Chapter_______ George W. Baker Chapter (Ft Rucker Area)______
Dues Structure: E-4 and Below: $10.00; E5 & E6: $15.00; E7, E8 &E9: $20.00; W1, W2, 01, 02 & 03: $25.00;
W4, W5, O4 and above, Prior Service and Retired: $35.00.
Enclose is $________for annual dues or $350.00 for Life Membership. Make check payable to USABAA and mail to:
USABAA
P.O. Box 126
Madison, AL 35758
Phone: 256-890-9119 / 256-759-063
Fax: 256-890-9196
E-mail: jnance@millennium-hsv.com
_____________________ _________________________________________________________
Date Signature
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