FOR THE GOOD OF THE ULTRLIGHT COMMUNITY
POB 589 phone 269-781-4021
Marshall, MI 49068, USA fax 269-781-7500
ASC Student Pilot
Application and Release Form (including annual ASC Membership registration)
Name ___________________________________________ Date of Birth d _____ / m _____ / y _______
Street Address __________________________________________________________________________
City, State, Zip _________________________________________________________________________
Phone ( ____ ) _________ - _________________ Email _______________________________________
1. Is this your 1st contact with ASC? __ yes __ no (member no. __________________________ )
2. How did you hear about ASC? _____________________________________________________
3. What aviation magazines do you read? _______________________________________________
4. What FAA Certificates (if any) do you hold? __________________________________________
I understand that ultralight flying is a potentially dangerous activity that may result in injury or death. I understand that ultralight flying is regulated by the Federal Aviation Administration under FAR Part 103 and its exemptions and that ultralight vehicles and ultralight flight instructors are recognized by ASC and are not certified by the FAA. It is the sole responsibility of each individual participating in ultralight activities to ensure his or her own safety and the airworthiness of the ultralight vehicle that he flies. I understand and agree that Aero Sports Connection, Inc., also known as ASC, is a private organization whose purpose is to support and promote ultralight aviation, and that ASC provides no regulation or control of individuals, instructors, or vehicles and there-fore ASC, its staff, and those listed, cannot be held liable or responsible for any flight operations that result in injury or death to any person or property damage of any kind.
I freely and voluntarily assume all risks associated with ultralight flight. I, and my heirs, promise to hold ASC, its staff, this instructor and those listed, harmless and blameless for any injury, death, or property damage that may result from my ultralight flying and from any ultralight instruction that I may receive. I understand that I am solely responsible for my safety and that I am solely responsible for attaining a thorough understanding of all information, procedures, and actions that are necessary to ensure a safe flight prior to beginning every flight. I certify that all statements made by me on this form are true and correct.
NO INSURANCE COVERS THIS FLIGHT TRAINING.
Instructor (name print) ________________________ number ___________ sign ___________________
Student must sign here: type of rating: ppg / ppw / pws / pfw / prw-g / prw-h / psp / pla
___________________________ date ___________ _________________________ date ___________
Student Signature Parent Signature (if student is a minor)
Send this from to: ASC Europe • HU-9671 Sitke • Kossuth u. 33. • Hungary • European Union • phone/fax: +36-95-442298
Q'I FI-01 © copyright 2005-2009 by ASC