CESSNA EMPLOYEE'S CLUB APPLICATION
& AUTHORIZATION FOR PAYROLL DEDUCTION FOR CLUB DUES
Name _____________________________ Date _________
Department No. _____________ Badge No. ______________
Home Add.__________________________________________
City_______________________State_______Zip___________
I hereby apply for membership in The Cessna Employees' Club (the "Club") and upon acceptance as noted below, I hereby authorize Cessna Aircraft Company ("Cessna") (or the subsidiary by which I am employed) to deduct from each paycheck, the amount of the monthly membership dues as established from time to time by the Board of Directors of the Club and certified to Cessna.
Signed __________________________________
Spouse:
Children living at home, names & ages: