Name: ________________________________________________

Address: ______________________________________________

Address: ______________________________________________

City: _________________________________________________

State: __________________________ Postal Code: ___________

Country: ______________________________________________

E-mail*: _______________________________________________

Telephone*:____________________________________________

The AEHS publishes a Directory of Members and encourages all members to be listed. For each participating member, the Directory will include name, postal address, telephone number, e-mail address, and interests (if provided). In order to protect your privacy, you will be listed in the Directory only if you give us permission to do so. The Directory will be mailed only to members of the AEHS. If you wish to be listed in the AEHS Directory of Members, please indicate so below:

_____ Yes, please include me in the AEHS Directory of Members*

If you wish, you may also state interests you would like to have included with your other information (limit 100 characters).

______________________________________________________*

______________________________________________________*

*Optional fields

Please enclose a bank draft or postal money order drawn on a US bank and payable to Aircraft Engine Historical Society, Inc.

Thank you for your support!

If you prefer to pay by credit card, please provide the following information:

Card Number:   _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiration Date:    _ _ / _ _    (mm/yy)

Name on Card:    ________________________________________