Regular Membership Application – LTD

Grey Eagle New Member Application with Long Term Disability with American Airlines Only! — ATTENTION:

(as of 1 Jan 2026)

DO NOT USE THIS FORM FOR ANY REASON IF YOU ARE ALREADY A GREY EAGLE!! 

Requirements:

1.     Must be an active or retired pilot of American Airlines (including all merged airlines)

2.     Must be 50 years old (or older)

3.     Long Term Disability with American Airlines

Long Term Disability – Regular Membership – $367.50 (includes 5% processing fee, using Paypal) or Credit Card:

***Instant Membership includes Instant Access to the Grey Eagles website ***

First Name:* First Name Required

Last Name:* Last Name Required

Middle Name: Middle Name is not valid

Prefix (e.g Dr.,Mr.,Mrs.,Ms.): Prefix (e.g Dr.,Mr.,Mrs.,Ms.) is not valid

Suffix (e.g. Jr.,II): Suffix (e.g. Jr.,II) is not valid

Employee # (6-Digit) :* Employee # (6-Digit) is Required

Date of Birth (mm/dd/yyyy):* Date of Birth (mm/dd/yyyy) is Required

Spouse or S/O FirstName: Spouse or S/O FirstName is not valid

Spouse MiddleName: Spouse MiddleName is not valid

Spouse NickName: Spouse NickName is not valid

Spouse Date of Birth (mm/dd/yyyy): Spouse Date of Birth (mm/dd/yyyy) is not valid

Street Address:* Street Address is Required

City:* City is Required

State (2 Letter Abbreviation):* State (2 Letter Abbreviation) is Required

Zip Code (9 Digit if possible):* Zip Code (9 Digit if possible) is Required

2nd Street Address: 2nd Street Address is not valid

2nd City: 2nd City is not valid

2nd State ( 2 Letter Abbreviation) : 2nd State ( 2 Letter Abbreviation) is not valid

2nd Zip Code ( 9 Digits if possible): 2nd Zip Code ( 9 Digits if possible) is not valid

Telephone # (xxx-xxx-xxxx format): Telephone # (xxx-xxx-xxxx format) is not valid

Cell Phone # (xxx-xxx-xxxx format): Cell Phone # (xxx-xxx-xxxx format) is not valid

Spouse CellPhone: Spouse CellPhone is not valid

Spouse or S/O Email: Spouse or S/O Email is not valid

Date of Hire (used by AA) (mm/dd/yyyy): Date of Hire (used by AA) (mm/dd/yyyy) is not valid

Retirement Date (if already retired) (mm/dd/yyyy): Retirement Date (if already retired) (mm/dd/yyyy) is not valid

Last/Current Base:* Last/Current Base is Required

Username:* Invalid Username

Email:* Invalid Email

*

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