Location Preference:
Start Date:
Locations:
Instructor Information (Type or Print)
Last Name _________________________________First Name____________________MI______
Military Rank (If Applicable) ________________________________________________
Social Security Number:________________________________________________
Street Address: ________________________________________________________
_____________________________________________________________________
City:____________________ State:___________________ Zip Code:________________
Date of Birth: YEAR________MONTH__________DAY_____ Sex:____________
Home Phone: Number__________________ For Instructor Shirts size we need your Height_____(inches) Wt _______ Weight______
Bus Phone: Number ____________________
Cell phone Number______________________
E Mail Address _________________________
Fax Number_____________________
Occupation:___________________________________________________________
Ratings or Flight Experience: ___________________________________________________________
Flight Hours:____________________
Education:
School(s):____________________ Dates:______________ Degree/Certif/Major:___________________
____________________ ______________ ___________________
____________________ ______________ ___________________
RETURN THE
COMPLETED FORM TO:
Judge Robert T. S. Colby
Director
Post Office Box 1945
Alexandria, Virginia
703-549-7722
Or
E-Mail: RTSC1@JUNO.COM