Fillable Membership Application (Air Line Pilots Association)

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Membership Application (Air Line Pilots Association)

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Air Line Pilots Association,
International
7950 Jones Branch Drive, Suite 400S
McLean, VA 22102
First Name Middle Name Last Name Suffix
List any alias or former name: Nickname:
Mailing Address Line 1:
Line 2:
Line 3:
City: Zip/Postal Code: Country:
State/Province: Email:
Primary Phone:
Cell Phone:
Date of Birth: SSN (U.S.)/SIN (CDN) (Optional):
Gender: Male Female Name of Emergency Contact:
Relationship: Email of Emergency Contact:
Emergency Contact Phone Number:
Current Airline Employment Information
Name of Airline: Employee or Payroll Number:
Domicile/Base: Aircraft: Position:
Date of Hire: Seniority Number:
Previous Employment in Aviation
Employer: Employed From: Employed To:
Flightcrew Member Education & Qualification
University and/or Flight School:
Were you a member of an ALPA Ace Club or Mentor Program at this school? Yes No
Did you attend an ALPA outreach event at this school? Yes No
Name:
Personal Information
via the
SUBMIT
button which will generate an email with the form as an attachment.
address above; emailed to
Membership@alpa.org;
faxed to (703) 464-2115; or submitted electronically
Please complete this form in its entirety. Completed and signed applications may be mailed to the
APPLICATION FOR MEMBERSHIP
Pilot License Type & Flight Time Record
Pilot License Type: U.S. Restricted ATP U.S. Full ATP Canadian ATP Commercial
Certificate Number:
How did you receive your flight training? (check all that apply):
University/College Flight Academy Flight School U.S. FAR Part 61 Program
U.S. FAR Part 141 Program Canadian or other non-U.S. civilian flight training
Flight Time Record (in Hours): + + =
Airline Military Other Total
Military Experience
Branch of Service:
Army (U.S.) Army (Canadian) Air Force (U.S.) Air Force (Royal Canadian) Navy (Royal Canadian)
Navy (U.S.) Marines (U.S.) Marines (Canadian) Coast Guard (U.S.) Coast Guard (Canadian)
Years of Service: From (YYYY): To (YYYY):
Current Status:
Discharged Retired Currently Serve - Reserves Currently Serve – National Guard Not Specified
Union Data
Have you ever applied for ALPA membership or worked for an ALPA represented carrier?
If, ‘Yes’: Airline: ALPA Number:
Signature
Upon approval of membership, I agree to pay the required fees, assessments, and annual dues.
I agree to abide by the Constitution and By-Laws of the Air Line Pilots Association, International, as they are now in force, or as
they may hereafter be amended, changed, modified, or adopted.
Signature: Date:
For Administrative Use Only
Membership Approval
The Applicant is: Approved Disapproved for Apprentice Reactivated Active
Membership by COUNCIL number: If disapproved, state reason:
Signature: Date:
(Council Officer or Designee)
Association Approval
The Applicant is: Approved Disapproved Assigned ALPA Number:
Signature: Date:
(Vice President – Administration)
or locked out by that airline?
Have you ever worked as a pilot
for an airline at
a time when its pilots, represented by ALPA, were authorized on
strike
Yes
No
If
‘Yes’:
Airline:
From:
To:
Yes No
0.00
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SUBMIT
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Membership Application (Air Line Pilots Association)

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Completed 22 September 2020

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