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NATIONAL EAA NUMBER EXPIRATION DATE OCCUPATION IF RETIRED FROM WHAT FIELD AERONAUTICAL RATING IF ANY AIRCRAFT OWNER BUILDER RESTORER ENTHUSIAST IF OWNER LIST MAKE S MODEL S AND N NUMBER OF AERCRAFT NOW OWNED BUILDER OR RESTORER LIST TYPE S OF AIRCRAFT UNDER CONSTRUCTION AND/ OR RESTORATION COMMENTS SIGNATURE Date AMOUNT PAID CHECK MAKE CHECK PAYABLE TO MAIL TO Van Vickers 1579 Old NDB road DeLand Fl 32724 Revised 05/26/2016 EAA CHAPTER 635 CASH Recommended By PHONE 386-956-0936. We...
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