Membership Application

Enter your Temporary ID to Update information

Fields marked with * are required for Submission

Personal Information

Name*

List any alias or former name

Nickname

Mailing Address Line 1*

Line 2

Line 3

City*

ZIP/Postal Code*

Country*

State/Province*

Primary Phone*

Cell Phone

Non-Company Email*

Date of Birth*

Gender*

Name of emergency contact

Relationship

Email of emergency contact

Phone

Current Airline Employment Information

Name of Airline*

Employee or Payroll Number*

Domicile / Base*

Aircraft*

Position*

Date of Hire*

Seniority Number

Previous Employment In Aviation

Please use the tool below to build your Employment History by completing the following fields and then selecting the Add button. There is no limit to the number of previous employments that can be added.

Employer

From:

To:

Flightcrew Member Education and Qualification

Please use the tool below to build your Flight Education & Qualification history by completing the following fields and then selecting the Add button. Multiple entries are allowed.

University and/or Flight School

Were you a member of an ALPA ACE Club or Mentor Program at this school?

Did you attend an ALPA outreach event at this school?

Pilot License Type & Flight Time Record

Pilot License Type

Certificate Number

How did you receive your flight training?(check all that apply)

U.S. Military University/College US FAR Part 141 Program US FAR Part 61 Program
US FAR Part 142 Program Canadian Flight School Canadian Military Other Training

Other Training

Flight Time Record (in Hours)

AIRLINE

MILITARY

OTHER

Total

Military Experience

Please use the tool below to build your Military Experience history by completing the following fields and then selecting the Add button. Multiple entries are allowed.

Branch of Service

Years of Service: From (yyyy):

To (yyyy):

Current Status

Union Data

Have you ever applied for ALPA membership or worked for an ALPA represented carrier?*

Airline?

ALPA Number

Have you ever worked as a pilot for an airline at a time when its pilots, represented by ALPA, were on authorized strike or locked out by that airline? *

If yes, give dates From

Airline?

ALPA Apprentice Member Insurance Opt-In Form

Apprentice members are eligible for complimentary insurance benefits under ALPA’s Loss of License, Group Term Life, Group Critical Illness, and Group Accident plans. Before insurance benefits will take effect, you must complete and submit this form with your coverage election, smoker/nonsmoker declaration, and designation of beneficiaries.

Plan design limitations and exclusions may apply. For complete details of coverage, including benefits, exclusions, and limitations, refer to your benefit booklet or certificate of insurance and riders. A copy of the benefit booklet is available from the Member Insurance Department, Insurance@alpa.org.

Apprentice Insurance Election Information: Please make an election below

I would like to apply for the VEBA complimentary benefit(s) that are listed below [PLEASE NOTE - YOU WILL RECEIVE AN EMAIL CONFIRMATION WITH INSTRUCTIONS TO REVIEW YOUR ELECTION AND UPDATE YOUR LIFE INSURANCE BENEFICIARIES ]:

Are you a Smoker ?

$1,200 Monthly Loss of License, underwritten by Guardian Life Insurance Company of America;
$50,000 Group Term Life, underwritten by Guardian Life Insurance Company of America;
Group Critical Illness Insurance ($10,000 maximum Critical Illness benefit) and Group Accident Insurance (benefit amounts depend on the type of injury and care received) underwritten by ReliaStar Life Insurance Company, a member of the Voya® family of companies. These are limited benefit policies. They are not health insurance and do not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
Coverage will begin on the first of the month following the date I elect coverage
I understand that the coverage is complimentary for 12 months following my date of hire, and
- A VEBA-sponsored supplement of 50% will apply to the coverage from the 13th to the 24th month following my date of hire.
- After 24 months, I will be billed the applicable published rates based on my age and smoker status. I will be automatically billed for payment of coverages unless I specifically request the cancellation of coverage and that I will be responsible for paying this coverage at the applicable rates.

I decline to enroll in noncontributory coverage paid for by ALPA.

Signature

Upon approval of membership, I agree to pay the required fees, assessments, and annual dues.

I agree to abide by the Constitution and By-Laws of the Air Line Pilots Association, International, as they are now in force, or as they may be hereafter amended, changed, modified, or adopted.

Signature*

Date*

I Accept*

Air Line Pilots Association, International

7950 Jones Branch Drive, Suite 400S, McLean, VA 22102

APPLICATION FOR MEMBERSHIP

Please complete this form in its entirety before submission. You can save your progress at any time and you will be issued a Temporary ID that will allow you to return and complete the form at your convenience.