Name:       

            Street:     

            City:       

            State:      

            Zip:        

            Phone:      

            Work Phone: 

            Email (required):     

            UTC Division:         

            Location:    

            Mail Stop:   

            Clock #:     

            Department:  

            AEFCU Member:

            Previous Club Member:

            Club #:       

            Membership type:    

            Spouse Name:        

            Spouse Membership Type: 

            Spouse Card:        


            Credit Card Type:    

            Name on Card:        

            Credit Card #:       

            Exp. Date(MM/YY):    

            Card billing address:

            Zip:                 



            Comments:

            

            

            



MEMBERSHIP APPLICATION/RENEWAL

The Pratt & Whitney Aircraft Club, Inc.

200 Clement Road / MS 122-03 / East Hartford, CT 06118
860-565-6236 Fax 860-569-1529

Payment of dues or gifts to the P&WA Club are not tax deductible, as a charitable contribution