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Join the Aeromedicos

Fields marked in red are required.

Yes, I would like to be a member of the Aeromedicos team. I'm sending a tax-deductible annual membership gift of:

$30	$50	$100	$250
Member	Family	Ground Crew	Navigator Circle
$500	$1000	$2500	$5000
Co-pilot Circle	Pilot Circle	Cadeje Circle	Baja Circle

Applicant Information
Please complete the following information as completely and accurately as possible.

Member 1 Name:
Member 2 Name:
Address:

City
State
Zip
Home Phone:
Work Phone:
Mobile Phone:
Fax:
email:
Passport # Member 1
Expiration Date Member 1	xx/xx/xxxx format
Passport # Member 2
Expiration Date Member 2	xx/xx/xxxx format
Weight:	Member 1: Member 2:

Personal Medical Conditions
Due to extreme travelling conditions, such as heat, long flying distances in small airplanes, and busing into isolated areas, please indicate any personal medical conditions that we should be aware of:

Emergency Contacts
In case of an emergency, please notify:

Yes, I would like to volunteer my services:

Medical capability or speciality:

Spanish Proficiency:

Other capabilities:

Pilots Only
Skip this section if you are not a pilot.

Ratings:
Current Airplane Owned:
N Number:

Waiver of Liability
All Aeromedicos members who intend to volunteer their services, in any capacity, must sign the Aeromedicos Waiver of Liability. The waiver is available as a PDF download and must be printed out and mailed separately. The witness must be a non-family member.

Click below to view the Waiver of Liability (link will open in a new browser window). To save the PDF file to disk for later viewing and/or printing, right-click (hold-click in MacOS) the link below and choose Save link as... or Save target as...

aeromedicos_waiver.pdf

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Aeromedicos of Santa Barbara
P.O. Box 538
Goleta, CA 93116