Air Line Pilots Association,
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
Personal Information
via the
button which will generate an email with the form as an attachment.
address above; emailed to;
faxed to (703) 464-2115; or submitted electronically
Please complete this form in its entirety. Completed and signed applications may be mailed to the
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:
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
Yes No
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