Mail Application to:

                       American Huey 369 Organization

                            209 S. Broadway  Peru, IN 46970

____Individual  Membership - $100.00

____Corporate/Non-Profit Membership - $500.00

____Lifetime Membership - $1,000.00

Payment Information: PLEASE FILL OUT COMPLETELY!

 cash __    check__   credit card__

MC__  Visa__ Discover__ 

Card#________________________

Expiration date___________

Security Code (back of card)____________

PLEASE PRINT: (If paying w/ credit card- name, address & phone must match card)

Name: ______________________________________________

Street Address:  _______________________________________

City:  ________________________ST:_______ ZIP:___________

Home Phone:  ________________Cell Phone: ________________

Email   Address:_______________________________________

Birthdate: __________ Prior/Current Military:    YES      NO   (Circle one)

If Yes, please provide your military information:

Last Rank in Service:  ____________________

Units Served in: ________________________

MOS: ________________________________

                                      Membership Benefits Include:

Admission to Hanger / Restoration Hanger

Newsletter – Huey News is available at  www.americanhuey369.com

Invitation to all Events

Membership Dog Tag

American Huey 369 apparel discounts

Are you interested in being a Volunteer/:      YES     NO      (Circle one)

All members are essential to our mission and are able to accompany us

on our flights on a space available basis.

FOR OFFICIAL USE ONLY:  

Date:  __________Event: _________Membership Number:  _______