EAA Canadian Council Application

EAA Membership Number:*

First Name*

Last Name*

Email*

Phone*

Please include area code.

Chapter Number:

If you are a member of an EAA chapter, please list the number

State/Province*

Select or enter value

Why do you want to serve on the Canadian Council?*

Background:*

Summarize your aviation experience

EAA Involvement*

Please list any EAA Involvement (e.g. chapters, Technical Counselor, Flight Advisor, Young Eagle pilot, Oshkosh volunteer, etc):

Conflict of Interest

Please list any possible conflicts of interest that may arise out of your serving on the council.