Sponsorship and Exhibit Opportunities! (check all that apply)

Return Application and Payment To: Kentucky Aviation Association, P.O. Box 22304, Lexington, KY 40522

Kentucky Aviation Conference

Not a KAA Member?  Sign-up Now! (check all that apply)

KAA accepts applications regardless of race, creed, sex, color, physical disability and national or ethnic origin

September 7-9, 2011 • Galt House Hotel & Suites • Louisville, Kentucky

2011 Registration Form

Name (First, Middle Initial, Last):                                                                                                                                               

Title:                                                                                                                                                                                           

Airport/Company:                                                                                                                                                                      

Mailing Address:                                                                                                                                                                        

City:                                                                                     State:                                            Zip Code:                                    

Phone:                                                                                 Fax:                                                                                                 

Email Address:                                                                                                                                                                           

□ Check Enclosed (made payable to KAA)  |  □ Credit Card      □MasterCard  □Visa  □American Express  □Discover

Name on Card                                                                                                                                                                            

Credit Card No.                                                      Exp. Date                        CSC No.           

Billing Zip Code                                                                                             Authorize Card to be Charged $                           

Email Address of Cardholder                                                                                                                                                     

Signature of Cardholder                                                                                                                                                             

For MasterCard or Visa, the last 3 digits in the signature area on the back of the card. For American Express, the 4 digits on the front of the card.