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Connecticut Parachutists, Inc. Membership Application

Please select an membership type.

I wish to apply for membership in Connecticut Parachutists, Inc. I certify I am at least eighteen (18) years old, or I am at least sixteen (16) years old and have obtained notarized written permission to join CPI from my parent or legal guardian.

First Name:

Required.*

Last Name:

Required.*

Mailing Address:

Required*

City:

Required

State: *

Zip: RequiredInvalid format.*

HM Phone:

Required*

Work Phone:

Other Phone:

(Cell, Fax, etc.)

Email Address:

RequiredInvalid format.*

Date of Birth:

* mm/dd/yyyy

USPA #:

Required*

Expiration Date:

Required.(MM/YY)

License#:

Required*

Exit weight:

Can we list your Name, Phone and email address in the online Member directory? Please Yes or No.

Please note:

Years Jumping:

Total Jumps:

Total Jumps Last Year:

Billing Information

Same as Member Information

First Name:

Last Name:

Address:

City:

State:

Zip:

Payment Information

Card Type:

Please select an item.*

Lifetime Members select "Lifetime Member"

Card #:

Required*

No dashes or spaces

Expiration:

Please select an item. Please select an item.*

Applicants for Parachutists Classification must be members of the United States Parachutists Association, must have made at least one sport parachute jump, and must abide by all regulations that govern sport parachuting. The Parachutist Member has the privilege of voting on all issues brought before the membership and at CPI Elections. Applicants for Associate Membership need not belong to USPA, need not have jumped and have no voting privileges unless they are a member of the Board of Directors. All Members must agree to abide by all club rules and regulations