FULL NAME (required)
EMAIL (required)
Street Address:
City: State: Zip:
Home Ph#: Mobile#:
Age:
Emergency Contact:
Medical Info:
Glider Make & Colors:
Hook in weight:
Harness & reserve type:
Years Flown:
Ratings and Sign-offs:
Clinics previously attended:
Total Airtime: Thermalling Hours:
Longest XC distance: Longest XC duration:
Local flying site:
Other Info & Clinic Goals:
Enter the code above here:
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