Ag Flight, Inc. Crop Dusting and Ag Pilot School

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Today is May 12, 2008

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AGRICULTURAL FLIGHT ADMISSIONS Please fill out the Applicant Form below. If you prefer to fill out the form later, you may print it out and submit the form via fax or postal mail. If you have any questions feel free to contact our Admissions Office at (229) 246-8200.

APPLICANT INFORMATION

Name:

Age:

Mailing
Address:

City/State/Zip:

Phone Number:

Preferred
Starting Date:

Marital
Status:

SSN #:

Pilot
License:

Yes
No

If Yes, Type and Number:

Medical:

1st Class
2nd Class
3rd Class

Exp. Date:

Date of
1st Solo:

Flying Time:

(if applicable)

Flying Time To Date (hrs):

Total Duo (hrs):

Total Solo or PIC (hrs):

Total In Last 90 Days (hrs):

Total In Last 12 Months (hrs):

NOTE: Please be sure to enter the Aircraft TYPE as well as the total flying time in the spaces allotted below if applicable.

Total Flying Time (hrs) In Conventional Gear Aircraft (Specify Time & Type):

Total Flying Time (hrs) In Other AirCraft (Specify Time & Type):

Any
Accidents:

Yes
No

Date and Nature of Violations If Any:

IN CASE

OF EMERGENCY, CALL:

Name:

Relationship:

Mailing
Address:

City/State/Zip:

Phone Number:

CAN YOU READ AND SPEAK THE ENGLISH LANGUAGE?

Yes
No

By submitting the above information and pressing "I Accept" below, I certify that the above information is complete and accurate to the best of my knowledge.

Please enter the following code in the box below: 12B2008

CONFIDENTIALITY STATEMENT: Any information submitted through our web site will be considered confidential and will not be shared with any outside parties for any reason except as may be required by law.

READY TO GET STARTED?
Contact us today and schedule your training.

AG- FLIGHT, INC.
P.O. Box 658
Bainbridge, GA 39818
Ph: (229) 246-8200
Email: PilotTraining@AgFlight.com