ONLINE
APPLICATION
REQUIRED FIELDS:
*First Name:
*Last Name:
*Email:
*Address:
*City:
*State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
NC
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
*Zip Code:
*Employer:
OPTIONAL:
1)
Over the past year, how many times have you traveled on commercial airlines?
2)
What are your 3 most frequent destinations?
3)
In which frequent flier programs do you participate?
The Bloomington Normal Airport Authority will NOT at any time share/sell or distribute this information with anyone. All information will remain private and confidential and shall only be used for the purpose of administering this program.
