I have flying hours
Preferred flying dates
Long
range / air race experience
Memberships
(Aeronautics)
Clubs, Organizations
in country/state
Occupation
Age
Nationality
Other Interests
Navigator
and/or
Rally
Crew Information
(where applicable)
For multiple entries,
please resend this form.
Mr./Mrs/Ms
Title
First Name
Last
Name
Street Address
City
State
/ Province
Zip
Country
E-Mail
Telephone
Fax
Please specify
function(s): Air -, ground support, etc.
Aircraft
Serial Number
Registration/Identification Number
/ VIN
Engine Type and HP
Engine Serial Number
Empy Weight (Kg)
Max Fuel (Litres)
Full Power Flight Speed (kts)
Power Off Stall Speed (kts)
Estimated rally speed
Estimated
daily distance in Km
"Certificate of Airworthiness",
"Permit to Fly",
or
other Ultralight operating
exemption from your countries' Civil Aviation Authority
Date
of issue / date of expiry
Certification of Medical Status and Compliance
I hereby certify that I have no known medical
condition or physical defect, which would make my operation
of an ultralight vehicle unsafe. I also certify that should
such a condition come to my knowledge, I will inform the organizers.
Comments
The moment we finalize
the detailed rally conditions, we shall require copies of your copies
of pilot, vehicle registration, and medical certificates,
airframe and engine logs, operating limitations, weight and balance
data, and a
Certificate of 3rd Party legal liability
insurance valid for the aircraft to be flown.
We may refuse to accept any application for entry if we believe
such entry is not in the best interests of the race.
Until
then, I thank you for your kind co-operation!
Please also send information to
(name and e-mail address):
Aeronautics Club, Organization
My friends
My business associate
It
is understood that your data shall be treated confidentially,
and used for organizational purposes only.
