aircrew identification card application - international

AIRCREW IDENTIFICATION CARD APPLICATION international business aviation council Name : ___________________________________________________________________________ Date of Birth: Place of Birth: __________________________________/___________________________/_______________________________________________ Nationality (country issuing passport): _____________________________________________________________________________________ Name of Your Corporation: ________________________________________________________________________________________________ Location of Your Corporation's Aviation Operation: _____________________________/__________________/_________________________ Position: Signature: Corporate Mailing Address: City State Country City State Country I I I I I I I I Day Month Year n n a a a n n (please sign in black ink above the line and within the box provided) Pilot Flight Attendant Engineer Technician _______________________________________________________/_____________________________/_________________________________________ _______________________________________/______________________________/______________/_________________________/______________ ________________________________________/________________________________________/___________________________________________ Name Title Company Street Address City State Country Postal Code Telephone Fax Email Name:_______________________________________________________ Title:_______________________________________________________ Date:________________________________________________________ Signed:_____________________________________________________ Step 1. Complete the Applicant Information section. Step 2. Have the Authorization section completed and signed by a company representative. Step 3. Enclose one color passport-type photograph with white background. Step 4. Please enclose a check payable to IBAC Aircrew Cards or complete the Credit Card Payment form on the back of this application. IBAC Aircrew Cards cost USD $70.00 each. Step 5. Mail to: IBAC Aircrew Cards Suite 16.33 999 University Street Montreal, Quebec H3C 5J9 Canada Tel: (514) 954 8054 Fax: (514) 954 6161 E-mail: [email protected] APPLICANT INFORMATION AUTHORIZATION **See details on the back of this application to learn how to customize your Aircrew Card to include your corporate logo** Member Number:____________________________________________ Aircraft Registration (2 max):_________________________________ If desired for inclusion on Card To Be Completed by a Company Representative To have your Aircrew Cards returned via courier, please include a courier account number (Fed Ex or UPS only):__________________________________ Please select the IBAC Affiliated Association of which your company is a member: Business ess AviationAssocia iation of of Sout outhern rnAfri frica The above applicant is employed by, and performs flight crew duties for, a Member Company of an IBAC Affiliated Association. The submitted photograph is that of the applicant. The Company assumes responsibility for the control and proper use of the Card and assumes all/any responsibility and liability arising from misuse of the Card. The Card is valid for three (3) years from the date of issue so long as the applicant remains in the Company's employ and the Company retains their affiliated association membership. The Company will be responsible for retrieving the Card from exiting employees and for returning such Cards to IBAC for cancellation. IBAC reserves the right to withdraw the Card at any time if, in its opinion, the Card is misused.

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AIRCREW IDENTIFICATION CARD APPLICATION

international business aviation council

Name : ___________________________________________________________________________ Date of Birth:

Place of Birth: __________________________________/___________________________/_______________________________________________

Nationality (country issuing passport): _____________________________________________________________________________________

Name of Your Corporation: ________________________________________________________________________________________________

Location of Your Corporation's Aviation Operation: _____________________________/__________________/_________________________

Position: Signature:

Corporate Mailing Address:

City State Country

Day Month Year

n n a a a n n

(please sign in black ink above the line and within the box provided)

Pilot Flight Attendant Engineer Technician

_______________________________________________________/_____________________________/_________________________________________

_______________________________________/______________________________/______________/_________________________/______________

________________________________________/________________________________________/___________________________________________

Name Title Company

Street Address City State Country Postal Code

Telephone Fax Email

Name:_______________________________________________________ Title:_______________________________________________________

Date:________________________________________________________ Signed:_____________________________________________________

Step 1. Complete the Applicant Information section.

Step 2. Have the Authorization section completed and signed by a company representative.

Step 3. Enclose one color passport-type photograph with white background.

Step 4. Please enclose a check payable to IBAC Aircrew Cards or complete the Credit Card Payment form on the back of this application.

IBAC Aircrew Cards cost USD $70.00 each.

Step 5. Mail to:

�

� IBAC Aircrew CardsSuite 16.33999 University StreetMontreal, QuebecH3C 5J9 Canada Tel: (514) 954 8054 Fax: (514) 954 6161 E-mail: [email protected]

APPLICANT INFORMATION

AUTHORIZATION

**See details on the back of this application to learn how to customize your Aircrew Card to include your corporate logo**

Member Number:____________________________________________ Aircraft Registration (2 max):_________________________________If desired for inclusion on Card

To Be Completed by a Company Representative

To have your Aircrew Cards returned via courier, please include a courier account number (Fed Ex or UPS only):__________________________________

Please select theIBAC Affiliated Associationof which your companyis a member:

Businessess Aviation Associaiation ofof Soutouthernrn Afrifrica

The above applicant is employed by, and performs flight crew duties for, a Member Company of an IBAC Affiliated Association. The submitted photograph is that of the applicant.The Company assumes responsibility for the control and proper use of the Card and assumes all/any responsibility and liability arisingfrom misuse of the Card.The Card is valid for three (3) years from the date of issue so long as the applicant remains in the Company's employ and the Companyretains their affiliated association membership.The Company will be responsible for retrieving the Card from exiting employees and for returning such Cards to IBAC for cancellation.IBAC reserves the right to withdraw the Card at any time if, in its opinion, the Card is misused.