Print this form and mail with your membership fee to the address below.

Please accept my application in the following category:

     ( ) Individual Membership  $20.00/year
     ( ) Family Membership  $30.00/year
     ( ) I would like to donate $_____________ to the Scholarship Fund

I would like to receive the newsletter by:

     ( ) US Mail
     ( ) E-Mail (Adobe Acrobate File)

Name:____________________________________________________________

Address:__________________________________________________________

City:_____________________________ State:________ ZIP:________________

E-Mail:___________________________________________________________

Status:  (  )Comm Pilot      (  ) Private Pilot       (  ) Crew

Balloon Name (if owner):_____________________________________________

Birth Date (no year)  ____ / ____

Phone (Home):  ___________________   (Work/Cell): _____________________

Family Information
(include Name, Birth Date, Status, E-Mail)

1.  ______________________________________________________________

2.  ______________________________________________________________

3.  ______________________________________________________________

4.  ______________________________________________________________

Mail Application to:

Balloon Association of Greater Illinois
P.O.Box 3314
Champaign, IL  61826