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Buffalo Mountain Flyers
Membership Form
Pilot’s Name (printed): ___________________________________________________ Age:_______
Address: ____________________________________________________ Apt. #: _______________
City: ______________________________________ State: ________________ Zip: _____________
E-mail address: _____________________________________________________________________
Home Phone: ( ______ ) _____ - ________ Work Phone (optional) ______ - ________ Ext. ______
USHGA Number: ___________________________ Expiration Date: __________________________
Spouse’s Name : ____________________________________________________________________
Pilot signature: _______________________________________________ Date: _____/_____/ 20___
Make check Payable to the “Buffalo Mountain Flyers”
Send to the Address below and include a check with your $60.00 Annual Fee.
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Allen Rahi
21686 Fairview Rd.
Spiro, OK
74959
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