"CENTURY FLIGHT 2011" REGISTRATION APPLICATION

In order to complete your registration, we first need to ask you a few questions. Please ensure that this information is accurate to prevent any errors on your application.


1. FULL NAME OF PILOT:
(Please only include ONE name or the registration won't work)


2. EMAIL ADDRESS:

3. PHONE NUMBER:

4. MAILING ADDRESS:
(Please fill out your FULL address)

5. AIRCRAFT TYPE:


6. AIRCRAFT REGISTRATION:


7. NUMBER OF PEOPLE:
(How many people are joining you in your aircraft, excluding the pilot)

8. DID YOU PARTICIPATE IN ANY PREVIOUS FLIGHTS?
(Did you participate in either the Cross Canada Century Flight or the Midnight Sun Challenge 2010 as a pilot?)
CHOOSE NO YES

9. IF YES, WHAT WAS YOUR CCF-PARTICIPANT NUMBER?
(This is the registration number issued to participants of the Cross Canada Century Flight 2009, if you don't have this number please leave it blank and we will issue you one)
# (Please write all three digits, ex. "023")

10. PAYMENT

COST is $695.00 + 12% HST
per 1 aircraft + 1 pilot + 1 passanger

$125 + 12% HST per extra passanger

If you wish, you can leave this section blank and call in your credit card number to complete this registration.

If you leave this portion blank, please be aware that your registration is incomplete and will not be processed until you call us with your payment information.

CALL CORY at 778-297-7377

Mon-Fri 8:30AM-4:30PM Pacific

11. CREDIT CARD TYPE?
CHOOSE VISA MASTERCARD AMERICAN EXPRESS

CREDIT CARD NUMBER:


EXPIRATION DATE
(Please write format 05/10)


12. COMMENTS:

ONCE YOU CLICK SEND, if your application is successful then you will be returned to the main Century Flight Club page.