| First Name: |
Male: |
| Last Name: |
Female: |
| Address: |
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| City: |
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| State: |
Country: |
| Zip + 4: |
Age: |
| Telephone: |
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| Email: |
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| *Parents
Name: |
Required for prospects under 18 years of age |
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| How
did you hear about CAP: |
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| Type
of Support You Are Interested In? |
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| Training
Interests: (Check All That Apply): |
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Aerospace Education |
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Aircraft Marshalling |
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Cadet Leadership Training |
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Chaplain / Moral Leadership |
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Disaster Relief |
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Drill & Ceremonies |
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Financial Management |
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Firearms Safety |
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First Aid & CPR |
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Glider Program |
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Homeland Security |
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Land Navigation |
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Military Training |
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Model Rocketry |
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Outdoor Skills |
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Professional Development |
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Public Relations / Marketing |
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Radio Communications |
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Search and Rescue - Aerial |
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Search and Rescue - Ground |
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Web Training / Developer |
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| Skills
You Can Offer: (Check All That Apply): |
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Aerospace Education Instructor |
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Firearms Safety Instructor |
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Cadet Mentor |
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First Aid & CPR Instructor |
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Radio Communications Instructor |
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Glider Instructor |
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Power Flight Instructor |
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Pilot, Balloon |
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Drill & Ceremonies Instructor |
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Retired Military |
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Finance / Administration |
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Model Rocketry Instructor |
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Land Navigation Instructor |
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Legal |
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Legislative Liaison |
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Homeland Security |
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Public Relations / Marketing |
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Pilot, Powered |
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Outdoor Skills Instructor |
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Pilot, Powered Instrument |
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Amateur Radio Operator |
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Amateur Radio, VE |
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| Demographics: (Check All That Apply): |
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AOPA Member |
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Air Force Association Member |
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Aircraft Owner |
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Armed Forces Active Duty |
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Armed Forces Reserve |
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Armed Forces National Guard |
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Armed Forces Retired |
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EAA Member |
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ARRL Member |
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FAA Certified Flight Instructor
(CFI) |
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Former CAP Member |
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NASAR Member |
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Law Enforcement Officer |
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Pilot, FAA |
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Soaring Society of America Member |
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Elected Official |
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Lawyer |
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Health Services (Doctor, Nurse,
EMT) |
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Sales / Advertising |
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U.S. Coast Guard Auxiliary |
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VFW / American Legion |
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American Red Cross |
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Kiwanis |
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Rotary |
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Firefighter |
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Clergy |
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Student, Middle School |
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Student, High School |
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Student, College (4 year) |
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Student, College (2 year) |
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| Comments: |
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