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COURSE

Please consider my enrollment for the following courses:


(Please indicate each course you wish to attend)
Private Pilot

) Commercial Pilot

Multi-Engine Rating (

) Flight Instructor (

Instrument Rating (
) ATP Program (

STARTING DATE :
I would like to begin on: (day/month/year) :..............................................
FLIGHT EXPERIENCE

Total flight time

: ............................................................

Dual Instruction

: ............................................................

Solo or Pilot in Command : ............................................................


Aircraft Types

: ............................................................

Medical Certificate Class : ............................................................


Medical Certificate dated : ............................................................
Limitations

: ............................................................

ACKNOWLEDGEMENT
The above information provided by me is true to my knowledge

..........................................................
(Applicant Signature over Printed Name)

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