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Contact Information:
First name*
Last name*
Citizenship (USA, Canada...)*
Phone 1*
Phone 2
Phone 3
Email 1*
Email 2

Memberships:
AOPA EAA OPA Angel Flight

Certificates, Ratings, and Endorsements Held:
*
Instrument
Complex
High-Performance
Multi-engine
Glider
CFI
CFII
MEI
Type Rating(s)

Flight Time:
Total*
PIC*
Instrument*
Complex or High Performance*
Multi-engine*
Experimental*
Glass Panel*
Diesel*
Turbine*

Aircraft we might fly (specify at least one):
Tail , Type , Time in type , Owner
Tail , Type , Time in type , Owner
Tail , Type , Time in type , Owner

Training Objectives (BFR, IPC, transition, new rating, proficiency):

Flying Objectives (commercial, sightseeing, TAA, cross-countries):

Comments:

Proposed First Session (time and date):