Entry Number _________(Assigned upon receipt by CD.) Circle Class: Novice Bronze Silver Gold

AMA # _______________ Current ? Yes No Radio Channel # _____________
 
 

PAID $______________ Cash Check # _________
 
 

______________________________ _____________________________ __________________ Last Name First Name Middle Initial

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Address

______________________ _______ _______ (____)______________________________

City State Zip Phone Number
 
 

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Primary Plane Color Scheme
 
 
 
 
 
 

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Backup Plane Color Scheme
 
 

I certify that I have test flown all registered aircraft and that my radio equipment meets or exceeds the AMA 1991 standard. My backup aircraft will be on the same radio frequency as my primary aircraft. I will examine my aircraft and equipment for any form of damage, excessive wear, or malfunction prior to all flights, and I will fly in a safe manner using my equipment throughout the entirety of this event. I will be in compliance and participate in the intent of the event.

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Signature Date