ࡱ>  [@  bjbj44 &ViVi!!!!"bJd# ) ) ) ) ),.7777)7s@;I$KRjM_I/ ) )//_I ) )J444/  ) )74/74B455 )X# g@!/55d2J0bJ52N/2N5$2N5//4/////_I_I4 SENIOR APPLICATION FOR SENIOR MEMBERSHIP IN CIVIL AIR PATROL (Type or print. Chaplains must use CAPF 35.)CHARTER NUMBERSOCIAL SECURITY NUMBER FORMTEXT       FORMTEXT      LAST NAME - FIRST NAME - MIDDLE INITIAL formtext       formtext       formtext   FORMCHECKBOX  MALE  FORMCHECKBOX  FEMALEHEIGHT formtext    WEIGHT formtext    BLOOD TYPE  FORMDROPDOWN DATE OF BIRTH DAY MONTH YEAR  FORMTEXT      MAILING ADDRESS (Number and Street) formtext      APT formtext     CITY  FORMTEXT       STATE formtext   ZIP CODE  FORMTEXT      HOME PHONE  FORMTEXT      Email address (This address may be used to contact you concerning CAP events, special interest items and other membership information)  FORMTEXT      NEXT OF KIN (Name and address)  FORMTEXT        FORMTEXT      RELATIONSHIP:formdropdown PHONE: ( FORMTEXT    )  FORMTEXT      MEMBER MOST RESPONSIBLE FOR YOUR JOINING CAP (OPTIONAL : For recruiting purposes) NAME CAPSN CHARTER #  FORMTEXT        FORMTEXT        FORMTEXT      EMPLOYED BY POSITION HELDWORK PHONE: (formtext    ) formtext       MAY WE CALL YOU AT WORK? formdropdown formtext      formtext      EDUCATION (ENTER NUMBER INDICATING YEAR COMPLETED: 9 - 20 or OTHER) GRADE COMPLETED  FORMDROPDOWN  DEGREE RECEIVED formtext      PROFESSION / TEACHING CERTIFICATE formtext      To help us better serve our members, please tell us how you heard about Civil Air Patrol (check all that apply): FORMCHECKBOX  Air Show  FORMCHECKBOX  NASCAR Race Program  FORMCHECKBOX  CAP Member  FORMCHECKBOX  Friend  FORMCHECKBOX  Magazine  FORMCHECKBOX  Family Member FORMCHECKBOX  CAP Exhibit  FORMCHECKBOX  School  FORMCHECKBOX  Radio  FORMCHECKBOX  Television FORMCHECKBOX  Other (please name): formtext      VOLUNTARY STATISTICAL INFORMATION (FOR DEMOGRAPHIC RESEARCH ONLY -- NOT REQUIRED FOR MEMBERSHIP) A: IDENTIFICATION: formcheckbox  WHITE formcheckbox  BLACK (NOT OF HISPANIC ORIGIN) formcheckbox  HISPANIC formcheckbox  ASIAN/PACIFIC ISLANDER formcheckbox  AMERICAN INDIAN/ALASKAN NATIVE B: INCOME formcheckbox  $0-$25,000 formcheckbox  $25,001-$50,000 formcheckbox  $50,001-$75,000 formcheckbox  $75,001-$100,000 formcheckbox  OVER $100,000BACKGROUND INFORMATION A. CITIZENSHIP 1. Are you a citizen of the United States? formdropdown  2. Are you an alien admitted for permanent residence? formdropdown _____ (Must possess current alien registration receipt card (Form I-151 or I-551). B. ARRESTS/CHARGES (WRITE  NONE IF APPROPRIATE) formtext      List on a separate sheet, all arrests or charges regardless of age or whether the record in your case has been sealed, expunged, or otherwise stricken from the court records. You must also include all military courts-martial or non-judicial punishment (Article 15, UCMJ or Captains Mast). Failure to provide all required information may result in your membership application being denied. (Note: You may exclude minor traffic violations unless drugs, alcohol or injury were involved.) C. prior military service (WRITE NONE IF APPROPRIATE)  FORMTEXT        FORMTEXT       formtext        FORMTEXT       Branch of Service Grade Discharge Date Discharge Type D. PRIOR CAP MEMBERSHIP (WRITE  NONE IF APPROPRIATE) from to  FORMCHECKBOX  CADET HIGHEST CADET AWARD EARNED formtext       formtext       formtext       formtext       formcheckbox  SENIOR HIGHEST GRADE EARNED formtext       Old Charter # Was your membership nonrenewed or terminated for cause? formdropdown  If yes, provide details on a separate sheet of paper.In applying for membership in Civil Air Patrol, I hereby execute the oath on the reverse side and understand and agree as follows: (a) To permit CAP to use my Social Security Number in my membership records as an identification number and to obtain background information from any person, corporation, or government agency (local, state, or federal) to be used to determine membership eligibility; (b) that if my membership eligibility is questioned, I will be notified and provided the reasons; (c) that prior to a final decision on my eligibility, I will have an opportunity to submit documentary evidence on my behalf; and (d) that CAP membership is a privilege and not a right and CAPs decision on my membership eligibility is final.APPLICANT SIGNATURE (Must be accompanied by FBI fingerprint card, FD-258)DATE formtext      To be completed by commander or designated representative: I certify that the applicant is accepted as a member of Civil Air Patrol subject to approval by higher headquarters with National Headquarters as the final approving authority. 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formcheckbox  AEROSPACE EDUCATION PROGRAM formcheckbox  CADET PROGRAM formcheckbox  EMERGENCY SERVICES formcheckbox  AEROSPACE EDUCATION OFFICER formcheckbox  DRILL AND CEREMONIES formcheckbox  CHECK PILOT formcheckbox  AEROSPACE EDUCATION INSTRUCTOR formcheckbox  DRIVER formcheckbox  COUNTERDRUG PILOT formcheckbox  CADET AEROSPACE OPPORTUNITIES formcheckbox  ENCAMPMENT STAFF formcheckbox  DISASTER RELIEF COUNSELOR formcheckbox  FLIGHT ENCAMPMENT STAFF formcheckbox  INSTRUCTOR PILOT formcheckbox  SPEAKER formcheckbox  INSTRUCTOR formcheckbox  SEARCH AND RESCUE formcheckbox  LEADERSHIP POSITION formcheckbox  GROUND TEAM formcheckbox  ORIENTATION PILOT formcheckbox  PILOT formcheckbox  SPECIAL ACTIVITES STAFF formcheckbox  OBSERVER/SCANNER formcheckbox  RADIO COMMUNICATIONS PLEASE LIST ANY OTHER SKILLS OR INTERESTS YOU HAVE WHICH MIGHT BE HELPFUL TO YOUR CAP UNIT. formtext      OATH OF APPLICATION (READ CAREFULLY BEFORE SIGNING FRONT OF APPLICATION!) I do solemnly swear (or affirm) that: I understand membership in Civil Air Patrol is a privilege, not a right, and that membership is on a year-to-year basis subject to annual renewal by CAP. I further understand failure to meet membership eligibility criteria will result in automatic termination at any time. I understand only Civil Air Patrol corporate officers are authorized to obligate funds, equipment, or services. I understand Civil Air Patrol is not liable for loss or damage to my personal property when operated for or by Civil Air Patrol. I voluntarily subscribe to the objectives and purposes of Civil Air Patrol and agree to be guided by the CAP constitution and Bylaws and comply with CAP rules and regulations as from time to time may be amended or promulgated. I agree to abide by the decisions of those in authority of Civil Air Patrol I certify that all the information on this application is presently correct and any false statement may be cause to deny membership. I understand I am obligated to notify Civil Air Patrol if there are any changes to the background information on the front of this form and further understand that failure to report such changes may be grounds for membership termination. I understand that this Oath of Application is a part of this application for senior membership in Civil Air Patrol and that my signature on the form constitutes evidence of that understanding. CAP FORM 12 REVERSE 2wrwwwwwxx8x{ d$If$If^kdp3$$Ifl    A 'v'0    4 la Vd$If^V $If^8x:xxxZy:zP{r`'g`'_Q>  ($If^ ,l$If<$If $ x" p@ kd4$$Ifl    JFx< '0        4 laxxZy\yvyxyzyyyyyyyyzzz:z{@{{{{{{{{{{{{{||| |\|^|x|z||||||||ȵȢȏ|iV$j:hdM 5CJOJQJU$jY:hdM 5CJOJQJU$j9hdM 5CJOJQJU$jm9hdM 5CJOJQJU$j8hdM 5CJOJQJU$j8hdM 5CJOJQJUhdM 5CJOJQJhdM CJOJQJjhdM 5CJOJQJU$j 8hdM 5CJOJQJU!|} }$}&}(}\}^}x}z}|}}}}}}}}}}}~~,~.~0~Z~\~v~x~z~~~~۵ۢۏ|i$j=hdM 5CJOJQJU$j=hdM 5CJOJQJU$j<hdM 5CJOJQJU$j1<hdM 5CJOJQJU$j;hdM 5CJOJQJU$jE;hdM 5CJOJQJUhdM 5CJOJQJjhdM 5CJOJQJUhdM CJOJQJ!~~~~~02LNPbd~ "NPȵȢȏ|i_RhdM 5@CJOJQJhdM CJOJQJ$jW@hdM 5CJOJQJU$j?hdM 5CJOJQJU$jk?hdM 5CJOJQJU$j>hdM 5CJOJQJU$j>hdM 5CJOJQJUhdM 5CJOJQJhdM CJOJQJjhdM 5CJOJQJU$j >hdM 5CJOJQJUP.0Xā4xiYJ $ d$x$If $ $If]$ $ x$Ifa$$  $Ifa$[kd.A$$Ifld`''04 la  f!$If  f!x$If  *,.0Xāތ 浱ujd hdM CJ hdM ;CJOJQJhdM CJOJQJhdM <B*phhdM CJOJQJhdM 5CJOJQJhdM OJQJhdM 5CJ(OJQJhdM hdM CJ"jhdM @CJUmHnHu j@hdM <@CJUhdM @CJjhdM @CJUhdM 5@CJOJQJ4܇t\ތ mf`' p'[kdA$$Iflz`''04 la $ $If $ x$If $ d$x$If $ dx$If $PP/ =!8"8#$%$$If!vh5P5 5 #vP#v #v :V l40    +5P5 5 / /  / 4f4vD Text20D SSAN ###-##-####!Enter your social security number$$If!vh5P5 5 #vP#v #v :V l40    +5P5 5 / / 4f4iDFNAME UppercaseiDFNAME UppercasefDMI UppercasevDeCheck12hDeD HEIGHT00Enter your height in INCHES (Centimeters / 2.54)Height in INCHESD WEIGHT0.Enter your weight in POUNDS. 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Chaplains must use CAPF 35.))%)%)))0)%)%)%<)%)%%00-)%% 2 ^ C%@ Arial-@Times New Roman- 2  d  2  d  2 2  d  2  d  C2 2  d  2  d  2 2  d  2  d  C2 2 L d  2 L d  2- 2 ~ d  8- 2 V  2 V  C2 2   2   2 2   2   C2 2   2   2 2   2   C2- 2 P  C8- @ !p-- @ !p^-- @ !:pd-- @ !p -- @ !Yp -- @ !p-- @ ! p-- @ !v-- @ !v^-- @ !v -- @ ! v---@ Arial- 2 Q WLAST NAME ''$*'/' 2 QW-C2 Q W FIRST NAME #*'$*'/' 2 QW-C"2 QW MIDDLE INITIAL/** '*$' 2 Q\W C--@ Arial- - 2 W 2 W 2 2 W 2 W C2 2 &W 2 &W 2 2 XW 2 XW C2 2 W 2 W 2- 2 W - 2 W 2 W C2 2  W 2  W 2 2 <W 2 <W C2 2 nW 2 nW 2 2 W 2 W C2- 2 W C 2 W 2 W 8- 2 &W *- ]@ Arial-  ]'- - 4c-- '-   2 x]  - 2 x] MALE/' '- 2 xm ]  $-  ]-  ]'- - c-- '-  2 ]  FEMALE#'/' ' 2  ]   @ Arial- - 2 Q  W HEIGHT*'-*$- 2 Q  W  "- 2   W  2   W  C2 2 1  W  2 1  W  2 2 c  W  2 c  W  C2- 2   W  C8- 2 Qi ] WEIGHT:'-*$ 2 QT ]  C- - 2 c ]  2 c ]  2 2  ]  2  ]  C2 2  ]  2  ]  2- 2  ]  #-- 2 Q  BLOOD TYPE' --*$&''- 2 QA  "- - 2    ''-   2    #- 2 B} DATE OF BIRTH*'$'-#'*$* 2 B7 - (2 t.DAY MONTH YEARL*'&/-*$*&''*- 2 t "- 2  2  C2 2  2  2 2 M 2 M C2 2  2  2 2  2  C2- 2  C8''- @ !-- @ !-- @ !W-- @ !W-- @ !^-- @ !p-- @ ! -- @ ! -- @ !R -- @ !W -- @ !W -- @ !Ti -- @ ! -- @ ! -- @ ! -- @ ! -- @ ! -- @ !-- @ !-- @ !!-- @ !-- @ !-- @ !-- @ !W-- @ ! -- @ !W -- @ ! -- @ !-- @ !--  @2 .#MAILING ADDRESS (Number and Street)/' *-'***'''* 1  ' - 2 . 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'-- @ ! -- @ !-- @ !-@Times New Roman--  2  RELATIONSHIP*' '$-*'*'- 2 I:-2 [ ''-   2  #- @ !-- @ ! -- @ !-- @ !i-- @ !-- @ !p-- @ !p-- @ !p-- 72 $NEXT OF KIN (Name and address*'%$-#'** 1    - 2 $) - 2 $@ 2 $@ C2 2 $r 2 $r 2 2 $ 2 $ C2 2 $ 2 $ 2 2 $ 2 $ C2- 2 $: C"-- 2  2  2 2  2  C2 2 & 2 & 2 2 X 2 X C2 2  2  2- 2  &'--  2 PHONE'*-*'- 2 o: (- 2  2  C& 2  2  & 2  2  C&- 2 ,)C- 2 A C- 2 ] 2 ] & 2  2  C& 2  2  & 2  2  C& 2  2  &- 2  #- @ !6-- @ !6-- @ !i6-- @ !6-- @ !g<-- @ !g<-- @ !g<-- t2 FMEMBER MOST RESPONSIBLE FOR YOUR JOINING CAP (OPTIONAL : For recruitin/'/''*/-'$*'''-*'' '#-*&-**-**-*''-'$-*' #    2 o g purposes    @ Arial- 2  )- 2   "- 2 4NAME*'/'- 2 4K - 2 4 CAPSN*'''*- 2 4  - 2 4CHARTER**'*$'*- 2 4 ## 2 4 "'- 2  2  C& 2  2  & 2  2  C& 2 4 2 4 & 2 Z 2 Z C&- 2  Cv- 2   2   & 2   2   C& 2 B  2 B  & 2 h  2 h  C& 2   2   &- 2   - 2  2  C& 2  2  & 2  2  C& 2  2  & 2 > 2 > C&- 2 d C#'- @ !-- @ ! -- @ !-- @ !i-- @ !-- @ !-- @ !- - 2   EMPLOYED BY'/' -&'*'&- 2 B  C 2 T  C#'z  -  2   w POSITION HELD'-'$-**' *- 2   w  C#'- @ !-- @ !-- @ ! -- @ ! -- @ !w -- @ !} -- @ !-- @ !A-- @ !Aw -- @ !A--  2 <  2 <  & 2 <  2 <  C& 2 <4  2 <4  & 2 <Z  2 <Z  C& 2 <  2 <  &- 2 <  *- 2 <  w  2 <  w  C& 2 <  w  2 <  w  & 2 <  w  2 <  w  C& 2 <8  w  2 <8  w  & 2 <^  w  2 <^  w  C&- 2 <  w  C*-- 2  } WORK PHONE:-*''*-*'- 2  } : (- 2 k}  2 k}  & 2 }  2 }  C& 2 }  2 }  &- 2 } )- 2 }  - 2 }  2 }  C& 2 4}  2 4}  & 2 Z}  2 Z}  C& 2 }  2 }  & 2 }  2 }  C&- 2 }  C"} '-- /2 E } MAY WE CALL YOU AT WORK?/'&:'*' &-*'$:-*' - 2 E}  C} -} 2 E}  ''-   2 EX}  C#- @ !-- @ !w -- @ !-- @ !j-- @ !jw -- @ !j-- 2  EC'Y2 4 DUCATION (ENTER NUMBER INDICATING YEAR COMPLETED: 9 ***'$-*'*$'***/''****'$*-&''**-/' '$'*  2  -C2    20 or OTHER)  -$*'*- 2 W   C"-@Times New Roman-- "2  GRADE COMPLETED-*'*'*-/' '$'*- 2 (  C - 2 :  ''-  2   C- 2   C#- "2   w DEGREE RECEIVED*'-*''*'*'''*- 2 9  w  C"- 2  (  w  2  (  w  & 2  N  w  2  N  w  C& 2  t  w  2  t  w  & 2   w  2   w  C& 2   w  2   w  &- 2   w  *- =2  !} PROFESSION / TEACHING CERTIFICATE'*-#'''-*$''***-*'*$#*'$'- 2 }  "- 2  }  2  }  C& 2  }  2  }  & 2  }  2  }  C& 2  }  2  }  & 2  ?}  2  ?}  C&- 2  e}  C*- @ !`-- @ !`-- @ !` -- @ !>` -- @ !` -- @ !y` -- @ !`w -- @ !`} -- @ !`-- @ !f-- @ !f -- @ !fw -- @ !f--m2 ATo help us better serve our members, please tell us how you heardu...*..*.****)*..C*C.**.*****.*..<&...**.R2 d / about Civil Air Patrol (check all that apply):*...6)52*.*.****.**..&- 2 r C '- @ !3 -- @ !Z 3 -- @ !3 -- @ !y3 -- @ !3 w -- @ !3 } -- @ !3 -- @ !r9 -- @ !r9 -W-W'--   --'-  2   W C+2  C WCAP Exhibit0--- %% 2  W C$W'WW'-- Y   --'-  2 S  W C+2 S C WSchool-"%%% 2 S  W C$W'WW'--   k --'-  2  W C+2 C WRadiol0%%% 2 W C$W'-W-W'--   --'-  2  W C+2 C WTelevision)%%!"%%- 2 p W C*W'- @ ! -- @ ! -- @ ! 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(FOR DEMOGRAPHIC RESEARCH ONLY )400-9440--000----00040),2 L --:2 x  NOT REQUIRED FOR MEMBERSHIP) 04(0-400-0)409-90-0-0- 2 C %'@ Arial-2 E A: )- "2 E IDENTIFICATION:*'*$#*'$-* 2 E  -'-- J  --'-  2 E  WHITE :*$' 2 E  '-- I  {--'-  J2 E * BLACK (NOT OF HISPANIC ORIGIN) ' '*'*-$-#*'''**-*-*'-- I ~  L --'-  2 E  HISPANIC*'''** 2 E  '-- I  --'-  2 E  ASI''(2 E +AN/PACIFIC ISLANDER'*''*#*' '**'* 2 E  '- 2  '--  y --'-  :2  AMERICAN INDIAN/ALASKAN NATIVE'/'**'***'*' ''''**'$'' 2    2  '-2 B: *- 2 INCOME**-/' 2  _-'--   n--'-  2  $0 2 -2 $25,000   2  '--   {--'-  2  $25,001  2 -#2 $50,000  '--  D  --'-  2 M  $50,001  2 - - 2 @ $75,000  '--  --'-  2  $75,001  2 - 2 $100,000  -'--  C --'-  2 L  OVER $100, -''* 2 000 2   '- @ ! -- @ ! -- @ ! W-- @ ! ]-- @ ! " -- @ ! ( -- @ ! -- @ ! -- @ ! --,2 BACKGROUND INFORMATION00004040000)4070)40 2  %- 2 A. CITIZENSHIP-0()-0-0- 2  %---L2 K4+1. Are you a citizen of the United States? %-%!%%%"!%%%%%0%%%-%%"%-2 K 0''- @ !_S--  2 Kf d- @ !dRf-a2 K9 2. Are you an alien admitted for permanent residence? %-%!%%%%%%%%%9%%%%%9%%%%%"%%%"%%-2 Kg 0''- @ !_Sg--   2 K_*-2 K____%%%% 2 K K'- g2  =(Must possess current alien registration receipt card (Form I /             # 1 2  -2 151 or I   2 -2 551 2 S).- 2 v $'-(2 B. ARRESTS/CHARGES 0-00--(-00-04---82 (WRITE NONE IF APPROPRIATE) B0)-040-)---04-0-)-- 2   2   C& 2 E  2 E  & 2 k  2 k  C& 2   2   &@Times New Roman- 2   - @ !" -- 2 A  K'- 2 DList on a separate sheet, all arrests or charges regardless of age or whether the record in your case has been sealed, expunged, or otherwise stricken from the                  (                  (     2 '12 court records. You must A    ' 2 ;2 c also include all military courts     2    2 ;- 2 Mmartial or non2    2 -2 [judicial punishment (Article 15, UCMJ or Captains Mast). Failure to provide all required    2 '   **2 *  2 #         '- s2 Einformation may result in your membership application being denied. (  2  2     2 2       @ Arial-2 Note:*# - L2 J + You may exclude minor traffic violations ' 2   2     S2 \ 0unless drugs, alcohol or injury were involved.)       (      2  "'--2 NC. 0)2 NPRIOR MILITARY SERVI-0409)(-0,--0-2 NCE0--:2 Nr (WRITE NONE IF APPROPRIATE) B0)-040-)---04-0-)-- 2 N  2 N  C& 2 N  2 N  & 2 N+  2 N+  C& 2 NQ  2 NQ  & 2 Nw  2 Nw  C&- 2 N  C- @ !JU - 2 N)  C%- 2 NN  2 NN  & 2 Nt  2 Nt  C& 2 N  2 N  & 2 N  2 N  C& 2 N  2 N  &- 2 N  n- @ !,VN - 2 Nz  &- 2 N  2 N  C& 2 N  2 N  & 2 N  2 N  C& 2 N 2 N & 2 N8 2 N8 C&- 2 N^ C- @ !U - 2 N< C- 2 N 2 N & 2 N 2 N C& 2 N 2 N & 2 ND 2 ND C& 2 Nj 2 Nj &- 2 N H- @ !U- 2 N '-%2  Branch of Service-%%"%%-%!"% 2 -  62 c Grade4%%% 2   u"2   Discharge Date0""%%%%0%% 2 q X 2 Discharge Type0""%%%%)!%% 2  $'-12 D. PRIOR CAP MEMBERSHIP I0-0400--9-90-0-0--72 (WRITE NONE IF APPROPRIATE))B0)-040-)---04-0-)- 2   K'- 2 _4 2 _Ffrom%9- @ !fF- 2 _ ;2 _ 2 _Tto%- @ !8fT- 2 _ >'-- e *--'- 2 _  CADET 0-0-) 2 _  42 _ HIGHEST CADET AWARD EARNED E040--)0-0-)-B-00--00-0- 2 _ 2 _ C& 2 _D 2 _D & 2 _j 2 _j C& 2 _ 2 _ & 2 _ 2 _ C&- 2 _ C- @ !f-- 2 _ CK'- 2 4 C- 2 G 2 G & 2 m 2 m C& 2  2  & 2  2  C& 2  2  &- 2  A- 2 F 2 F C& 2 l 2 l & 2  2  C& 2  2  & 2  2  C&- 2  C- 2  2  & 2 . 2 . C& 2 T 2 T & 2 z 2 z C& 2  2  &- @ !G-- 2   2  '--  --'- 2   SENIOR --040 2 Q  a+2  HIGHEST GRADE EARNED 040--)40-0---00-0- 2  2  C& 2 @ 2 @ & 2 f 2 f C& 2  2  & 2  2  C&- 2  C- @ !- 2  C$' 2  C 2 XOld Charter # 4%0%%%% 2  C$'-_2 g48Was your membership nonrenewed or terminated for cause? A%%"))<%<)%%)))))%)%5%))%<)%%))%%)%%)@ Arial-- 2 g  ''- @ !p -- =2 ga ! If yes, provide details on a se"%%))%)%)%%%))%%%,2 g(parate sheet of paper.)%%%%)%%))%)%- 2 g C%'- @ !: -- @ !_: -- @ !: -- @ !7@ -- @ !7@ --2 In applying for membership in Civil Air Patrol, I hereby execute the oath on the reverse side and understand and agree as follows:)%))%)))<%<)%%)))0%0-%))%%)%%%%%)%)%)%))))%%%%%%%)%%)))))%%%))%))%)%%%%))4% 2  C%-2 (a)$- 2  C2 aTo permit CAP to use my Social Security Number in my membership records as an identification numb)%%%90--%%"%9!-%"%-%"%!0%9%%%9!9%9%%"%%%"%%"%"%%%%%"%%%%%9%42  er and to obtain background%%%%%%%%%%%""%%%%% 2 * CK2 finformation from any person, corporation, or government agency (local, state, or federal) to be used to determine membership eligibility; %%9%%%%9%%!%%"%%"%%%%%%%%%!%%9%%%%%%"!%"%"%%%%%%%%%%%"%%%%%%9%%9%9%%"%%%%%! 2 fW CK-2 (b))-2 W that if my membership eligibility is questioned, I will be notified and provided the r%%9!9%9%%"%%%%%!"%%%"%%%%/%%%%%%%%%%%!%%%%%2 n easons; %%"%%"-2 l (c)%-C2  % that prior to a final decision on my%%%%%%%%%%""%%%%9! 2  CK-2 Yeligibility, I will have an opportunity to submit documentary evidence on my behalf; and d%%%!/%%!%%%%%%%%%!%"%%9%%"%9%%%!%!%%%"%%%9!%%%%%%%-2  (d))-O2  - that CAP membership is a privilege and not a%%0--9%9%%"%%"%%!%%%%%%%%% 2 e CKh2 _>right and CAPs decision on my membership eligibility is final%%%%%0--"%%""%%%%9!9%9%%"%%%%%!"%% 2 _.C 2 _ C%- @ !w-- @ !_w-- @ !w-- @ !}-- @ !}-- 2 XAPPL***##2 EXICANT SIGNATURE -*-&*1-*&--*-S2 0X(Must be accompanied by FBI fingerprint card, FD5&#&####&8&#&#&&"&-&&#&&##&&- 2 e X-C2 z X258)###- 2  X C#- 2 ^DATE-*&* 2 /^ C"- 2 ^ 2 ^ & 2 ^ 2 ^ C& 2 ^ 2 ^ & 2 ^ 2 ^ C& 2  ^ 2  ^ &- 2 F^ #- @ !t-- @ ! t-- @ !tX-- @ !t^-- @ !t-- @ !z-- @ !zX-- @ !z--e2 <To be completed by commander or designated representative: ())%%)<)%%))"%)<<%))%))%%))%%)%)%%%)%%%-y2  II certify that the applicant is accepted as a member of Civil Air Patrol "%!%%%%%%%"%%"%""%%%%%"%9%9%%%0!--%%2 ssubject to approval by higher headquarters with National Headquarters as the final approving authority. Membership"%%%"%%%%%!%%!%%%%%%%%%%%%"/%0%%%%0%%%%%%%"%"%%%%%%%%!%%%%%%!7%9%%"%%(2 8 becomes effective e%%"%9%"%%"!%2 :when this application is processed by National Headquarters and the individuals name appears on the National Headquarters database./%%%%"%%%"%%%"%%"%""%%%!0%%%%0%%%%%%%"%%%%%%%!%%%"%%9%%%%%%"%%%%0%%%%0%%%%%%%"%%%%%"% 2 : %- @ !Y-- @ ! Y-- @ !YX-- @ !Y^-- @ !Y-- @ !_-- @ !_-- :2 CHARTER, UNIT NAME, AND ADDRESS**'*$'***$*'/''**'***''' 2  - 2  2  C& 2   2   & 2 2 2 2 C& 2 X 2 X & 2 ~ 2 ~ C&- 2  C%- @ !_-- @ !__-- @ !_-- @ !e-- @ !e--.2 ]1TYPE OR PRINT FULL NAME)---40-00))0%%0-7- 2 ]O1 C$- 2 1 2 1 & 2 1 2 1 C& 2 1 2 1 & 2 41 2 41 C& 2 Z1 2 Z1 &- 2 1 *-2 ]a7XSIGNAT-40-)2 ][ 7XURE00- 2 ] 7X %-2 ]^DATE0-)- 2 ];^ $- 2 ^ 2 ^ C& 2 ^ 2 ^ & 2 ^ 2 ^ C& 2 ^ 2 ^ & 2  ^ 2  ^ C&- 2 F^ C*- @ !-- @ !-- @ !1-- @ !!7-- @ !X-- @ !^-- @ !-- @ !-- @ !-- @ !-- @ !-- @ !1-- @ !1-- @ !C-- @ !X-- @ !X-- @ !j-- @ !-- @ !-- @ !-(2 (CAP FORM 12, MAR 03N622.:6=**=26** 2 ( CY2 (F FRONT.6:6- 2 (\ C)2 (rPREVIOUS EDITIONS WI2622:6226-:62K)2 ( LL NOT BE USED AFTER**6:-2262262.-262 (N  30 JUN 03**&66** 2 ( CP"2 (OPR/ROUTING: DP:266:6-6:62 2 ( C('-                    ՜.+,0L px  . J SandersonCivil Air Patrol, Inc.7{ 6Application for Senior Membership in Civil Air Patrol Title