EAA Chapter 21 Application

EAA Chapter 808
Young Eagles
Information Request

Print this page with your browser (set margins to .75" or smaller, portrait orientation), fill it out, and mail it in.

Please Note: This is not the registration form. The registration form will need to be filled out
and signed by a parent or guardian on the day of the event.

Name:

^{_______________________________}

AGE:

^{________________}

Address1:

^{_______________________________}

Address2:

^{_______________________________}

City:

^{_______________________________}

State:

^{_______________________________}

Zip:

^{_______________________________}

E-mail:

^{_______________________________}

Home Phone:

^{_______________________________}

How did you hear about the Young Eagles Program? ________________________________________

Additional comments may be written on the back. *NOTE: Prior participation does not prohibit additional flights, but program goals give priority to new participants. Registration and benefits will occur only once.

Please return this form to:

Charlene Gardner
Young Eagles Coordinator
Need Address

Name:	^{_______________________________}	AGE:	^{________________}
Address1:	^{_______________________________}
Address2:	^{_______________________________}
City:	^{_______________________________}
State:	^{_______________________________}
Zip:	^{_______________________________}
E-mail:	^{_______________________________}
Home Phone:	^{_______________________________}