CHGPA Membership Renewal Form
	(Please complete, print, and then mail to the CHGPA Treasurer)
First Name:
Last Name:
Address:
City, State:	,
Zip Code (Please use zip+4):	-
Home Phone:	() - Work Phone: () -
Cell Phone:	() -
E-mail address:
CHGPA Forum username:	(if you have already registered)
Emergency contact name:
Emergency contact phone:
USHPA #	Expires:    (mm/dd/yyyy)
HG Ratings:	Observer: () Yes    () No
Wings:
PG Ratings:	Observer: () Yes    () No
Wings:
HAM Call Sign:

	Quantity
Membership types: CHGPA Flying Member ($40) MHGA Flying Member ($40) Joint CHGPA/MHGA ($55) Non-flying membership($25) Pulpit-sticker only ($15)	$
Site Acquisition Fund	$
Site Maintenance Fund	$
Total:	$

Please exclude me from the members-only online roster at the club website.
Do not mail me the newsletter; I will read Skyline on the web.