2012 Mesilla Valley Balloon Rally
Pilot Registration Form
Please return this form, with your pilot fee check made out to "MVBR", by
November 1, 2011 to: MVBR, Janette Stone. 5013 Hacienda Ave. Las Cruces, NM 88011. Check must be sent with this form.PEASE PRINT OR TYPE THE INFORMATION BELOW.
PILOT INFORMATION
|
Name |
Phone |
|
Address |
Fax |
|
City / State / Zip |
Cell |
|
Pilot Certificate No. PP or CP (circle one) |
Date of Last Flight Review |
|
E-mail Address |
Circle one: Sat. Afternoon fun flight Glow Both |
|
Jacket Size: M L XL XXL (circle one, if given) |
Shirt Size: M L XL XXL (circle one, if given)) |
|
Pilot Fee Check enclosed ($75.00 made out to MVBR) |
Your check will be held until you are officially accepted |
BALLOON INFORMATION
|
Name |
Make / Model |
|
Year |
Size |
|
Registration No. |
Date of Last Annual |
|
Description Please send a picture of your balloon, with your name and the balloon name included, to Janette Stone @ address on cover letter. |
|
INSURANCE INFORMATION
To expedite registration, please send proof of insurance and copies of logbooks with this registration
|
Name |
Phone |
|
Address |
Fax |
|
City / State / Zip |
Cell |
|
Pilot Certificate No. PP or CP (circle one) |
Date of Last Flight Review |
|
E-mail Address |
Circle one: Sat. Afternoon fun flight Glow Both |
|
Jacket Size: M L XL XXL (circle one, if given) |
Shirt Size: M L XL XXL (circle one, if given)) |
|
Pilot Fee Check enclosed ($75.00 made out to MVBR) |
Your check will be held until you are officially accepted |
SPONSORSHIP INFORMATION
If you have a sponsor, please fill in the name below. Self-sponsor fees: $500 non-corp $700 for corporate. Plus $75.00
|
Name
|
Phone/or email: |