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FILES!
Processing Pilot &Flight Instructor Certification Files
OBJECTIVE:
PILOT EXAMINERS WILL BE ABLE TO DEMONSTRATE THEIR ABILITY TO ACCURATELY PROCESS THE AIRMAN APPLICATION (4-00)
A File return rate greater than 10 percent is
UNACCEPTABLE!!!
FAA FORM 8710-1
4-00
NumberofFreeFlights
agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have read and understand the Privacy Act statement that accompanies this form.
TYPE OR PRINT ALL ENTRIES IN INK Form Approved OMB No: 2120-0021
Airman Certificate and/or Rating ApplicationDEPARTMENT OF TRANSPORTATIONFEDERAL AVIATION ADMINISTRATION
I Application Information Student Private Commercial Instrument
Other ___________________
Additional Rating Rotorcraft
Reexamination
Additional Instructor Rating
Reissuance of ____________CertificateMedical Flight Test
Powered-LiftBalloonAirplane MultiengineAirplane Single-Engine
Ground InstructorFlight Instructor ____ Initial _____ Renewal ____ Reinstatement
Recreational Airline Transport
A. Name (Last, First, Middle) B . SSN ((US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U.Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? NoYes
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other________H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G.Do you read, speak, write, & understand the English language? Yes No
L. SexMaleFemale
P. Date Issued
V. Date of Final Conviction
II. Certificate or Rating Applied For on Basis of:
A. Completion of Required Test
B. Military Competence Obtained in
C. Graduate of Approved Course
D. Holder of Foreign License Issued By
1. Aircraft to be used (if flight test required) 2a. Total time in this aircraft/SIM/FTD
1. Service 2. Date Rated
4a. Flown 10 hours as pilot in command in last 12 months in the following Military Aircraft.
1. Name and Location of Training Agency or Training Center
2. Curriculum From Which Graduated
1. Country 2. Grade of License
4. Ratings
hours
2b. Pilot in command
hours
3. Rank or Grade and Service Number
1a. Certificate Number
3. Date
3. Number
E. Completion of AirCarrier’s ApprovedTraining Program
1. Name of Air Carrier 2. Date 3. Which Curriculum
Initial Upgrade Transition
Instrument Cross Country PIC
CrossCountrySolo
NightInstr.Rec’d
Night Take-off/Landing
Night PIC
Night Takeoff/ Landing PIC
Number of Flights
Number ofAero-tows
Number of Ground Launches
Number of Powered Launches
Cross Country Instruction Received
Pilot in Comand (PIC)
Total Instruction Received
III Record of Pilot time ( Do not write in the shaded areas. )
Airplanes
Rotorcraft
Powered Lift
Gliders
Lighter Than Air Simulator
IV. Have you failed a test for this certificate or rating ? Yes No
V. Applicant’s Certification -- -- I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledgeand I agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have also read and understand the Privacy Act statementthat accompanies this form.
Signature of Applicant Date
TrainingDevice
PCATD
FAA Form 8710-1 (4-00) Supersedes Previous Edition NSN: 0052-00-682-5007
Airship Glider
4b. US Military PIC & Instrument check in last 12 months (List Aircraft.
S o l o
PIC SIC PIC SIC PIC SIC
PIC SIC PIC SIC PIC SIC
PIC SIC PIC SIC PIC SIC
PIC SIC PIC SIC PIC SIC
APPLICATION INFORMATION
TYPE OR PRINT ALL ENTRIES IN INK Form Approved OMB No: 2120-0021
Airman Certificate and/or Rating ApplicationDEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION
I Application Information Student Private Commercial Instrument
Other _______________________
Additional Rating Rotorcraft
Reexamination
Additional Instructor Rating
Reissuance of _______________CertificateMedical Flight Test
Powered LiftGliderAirplane MultiengineAirplane Single-Engine
Ground InstructorFlight Instructor ____ Initial _____ Renewal ____ Reinstatement
Recreational Airline Transport
AirshipBalloon
Lighter Than AirAircraft
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write, & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
PERSONAL INFORMATION AND
IDENTIFICATION DATA
W
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
A. Name
A. Name (Last, First, Middle)•Legal name -- Maximum 3 names•No Middle Name -- “NMN”• Middle Initial Only -- “ Initial Only”• Jr. , II, etc. -- Indicate
A. Name (Last, First, Middle)
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height
.
I. Weight
.
J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
PERSONAL INFORMATION AND
IDENTIFICATION DATA
B. SSN (US Only)
MUST CONTAIN ONE OF THE FOLLOWING:•“NONE” -- IF NEVER ISSUED.•“DO NOT USE”• U. S. SOCIAL SECURITY NUMBER• IT IS NOT TO APPEAR ON AN “ORIGINAL ISSUANCE” AIRMAN CERTIFICATE.
B. SSN (US Only)
NEW GUIDANCE CONCERNING CERTIFICATE NUMBERS
(THIS AFFECTS ONLY THOSE APPLICANTS WHO CURRENTLY USE THEIR SS# AS THEIR CERTIFICATE #)
DURING CERTIFICATION - IF THE APPLICANT WISHES TO REMOVE THEIR SSN FROM THEIR
PILOT CERTIFICATE, AND CHANGE TO A UNIQUE NUMBER, YOU MAY DO SO - IT IS THE
APPLICANT’S CHOICE.
HOWEVERALL INITIAL CFI CERTIFICATES WILL NOW BE ISSUED A UNIQUE CERTIFICATE NUMBER AND
WILL CAUSE THE PILOT CERTIFICATE TO BE RE- ISSUED USING THE SAME UNIQUE CERTIFICATE
NUMBER (LESS THE “CFI” SUFFIX)
NEW AIRMAN CERTIFICATE(FRONT)
NEW AIRMAN CERTIFICATE(BACK)
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height
.
I. Weight
.
J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write, & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
PERSONAL INFORMATION AND
IDENTIFICATION DATA
C. Date of Birth Month Day Year
C. DATE OF BIRTH • EIGHT DIGITS • MONTH FIRST • AGREES WITH OTHER DOCUMENTS
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
D. Place of Birth
D. Place of Birth
• CITY & STATE• COUNTY & STATE IF CITY IS UNKNOWN• CITY & COUNTRY IF OUTSIDE THE USA
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address (Please See Instructions Before Completing)
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height
.
I. Weight
.
J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
E. Address
City, State, Zip Code
E. Address• PERMANENT MAILING ADDRESS• P. O. BOX or RURAL ROUTE
• INCLUDE EXPLANATION FOR NO STREET ADDRESS AND A MAP TO, OR DESCRIPTION OF, RESIDENCE LOCATION.
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes pertaining to narcotic drugs, marijuana, or depressant
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
PERSONAL INFORMATION AND
IDENTIFICATION DATA
Other____________USA
F. Citizenship Specify
F. Citizenship
• USA CHECKED OR•CHECK OTHER & SHOW•COUNTRY OF CITIZENSHIP
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight
J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
Yes No
G. Do you read, speak, write & understand the English Language?
G. Do you read, speak, write, & understand the English Language?
• MAKE SURE EITHER “YES” OR “NO” HAS BEEN MARKED• THE APPLICANT’S OPINION
PERSONAL INFORMATION AND
IDENTIFICATION DATA
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
I. Weight
.
J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
H. Height
H. Height
• WHOLE INCHES• CONVERT FROM METERS, ETC.
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
I. Weight
I. Weight
• WHOLE POUNDS• CONVERT WHEN NECESSARY
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
PERSONAL INFORMATION AND
IDENTIFICATION DATA
J. Hair
J. Hair
• SPELLED OUT• BLACK, RED, BROWN, BLOND, GRAY, or BALD
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. (Citizenship) Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
K. Eyes
K. Eyes• SPELLED OUT• BLUE, BROWN, BLACK, HAZEL, GREEN, or GRAY
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold , or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
PERSONAL INFORMATION AND
IDENTIFICATION DATA
L. Sex
Male
Female
L. Sex
• MAKE SURE AN ANSWER IS MARKED
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
PERSONAL INFORMATION AND
IDENTIFICATION DATA
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
• ANSWER IS “NO” IF APPLICATION IS ON BASIS OF FOREIGN LICENSE OR MILITARY COMPETENCE.
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
N. Grade Pilot Certificate
N. Grade Pilot Certificate
STUDENT, RECREATIONAL, PRIVATE, COMMERCIAL, OR ATP
NOT FLIGHT INSTRUCTOR
PERSONAL INFORMATION AND
IDENTIFICATION DATA
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
X. Date
PERSONAL INFORMATION AND
IDENTIFICATION DATA
O. Certificate Number
• COMPARE WITH THE APPLICANT’S CERTIFICATE.
O. Certificate Number
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship) Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
V. Date of Final Conviction
PERSONAL INFORMATION AND
IDENTIFICATION DATA
P. Date Issued
P. Date Issued
• AS SHOWN ON THE CERTIFICATE.
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship) Specify
USA Other____________
H. Height
.
I. Weight
.
J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
PERSONAL INFORMATION AND
IDENTIFICATION DATA
Q. Do you hold a Medical Certificate?
Yes
No
Q. Do you hold a Medical Certificate?
• ASSURE THAT AN ANSWER IS MARKED.
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon
Signature
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
PERSONAL INFORMATION AND
IDENTIFICATION DATA
R. Class of Certificate
R. Class of Certificate
• ENTRY MUST BE CLASS SHOWN ON CERTIFICATE (FIRST/1st, SECOND/ 2nd, or THIRD/3rd)
Minimum Medical Certificate Class
1. Glider or Balloon - None2. Recreational Pilot - Third3. Private Pilot - Third4. Commercial Pilot - Third
(cont)
Minimum Medical Certificate Class
5.Airline Transport Pilot - Third6. Instrument Rating - Third7. Additional Category/Class - Third8. Flight Instructor - None?
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
NoYes
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
V. Date of Final Conviction
PERSONAL INFORMATION AND
IDENTIFICATION DATA
S. Date Issued T. Name of Examiner
S. Date Issued T. Name of Examiner
• MAKE SURE ENTRIES MATCH CERTIFICATE
A. Name (Last, First, Middle) B . SSN (US Only)
E. Address (Please See Instructions Before Completing)
City, State, Zip Code
M. Do you now hold, or have you ever held an FAA Pilot Certificate?
Yes No
Q. Do you hold a Medical Certificate?
Yes
No
C. Date of BirthMonth Day Year
D. Place of Birth
F. Citizenship Specify
USA Other____________
H. Height I. Weight J. Hair K. Eyes
R. Class of Certificate S. Date Issued T. Name of Examiner
N. Grade Pilot Certificate O. Certificate Number
G. Do you read, speak, write & understand the English Language?
Yes No
L. Sex
Male
Female
P. Date Issued
PERSONAL INFORMATION AND
IDENTIFICATION DATA
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
Yes No
U. Have you ever been convicted ... ?
• NOT ALCOHOL RELATED• ASSURE THAT EITHER YES OR NO HAS BEEN MARKED.• DATE OF FINAL CONVICTION.
V. Date of Final Conviction
V. Date ...
II. Certificate or Rating Applied For on Basis of:
A. Completion of Required Test
B. Military Competence Obtained in
C. Graduate of Approved Course
D. Holder of Foreign License Issued By
1. Aircraft to be used (if flight test required )
1. Service 2. Date Rated
4a. Flown10 hours PIC in last 12 months in the following Military Aircraft.
1. Name and Location of Training Agency of Training Center
2. Curriculum From Which Graduated
1. Country 2. Grade of License
4. Ratings
hours
2b. Pilot in command
hours
3. Rank or Grade and Service Number
1a. Certificate Number
3. Date
3. Number
E. Completion of Air Carrier’s Approved Training Program
1. Name of Air Carrier 2. Date 3. Which Curriculum
Initial Upgrade Transition
CERTIFICATE OR RATINGAPPLIED FOR ON BASIS OF:
4b. US Military PIC & Instrument check in last 12 months(List Aircraft)
2a. Total time in this aircraft / SIM / FTD
III RECORD OF PILOT TIME
Instrument Cross Country PIC
Cross CountrySolo
Night Instruction Received
Night Take-off/Landing
Night PIC Night
Takeoff/ Landing PIC
Number of Flights
Number ofAero-Tows
Number ofGround
Launches
Number of Powered Launches
Cross CountryInstructionReceived
Pilot in
Command(PIC)
SoloInstruction Received
Total
III Record of Pilot time (Do not write in the shaded areas.)
Airplane
Lighterthan Air
Rotor-craft
IV. Have you failed a test for this certificate or rating ? Yes No
V. Applicant’s Certification -- I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledgeand I agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have also read and understand the Privacy Act statementthat accompanies this form. Signature of Applicant
FAA Form 8710-1 (4-00) Supersedes Previous Edition NSN: 0052-00-682-5007
Date
TrainingDevice
Simulator
PIC
PIC
PIC
SIC
SIC
SIC
PIC
PIC
PIC
SIC
SIC
SIC
PIC
PIC
PIC
SIC
SIC
SIC
PIC
PIC
PIC
SIC
SIC
SIC
Gliders
PoweredLift
PCATD
CHECK FLIGHT TIME!
CHECK FLIGHT TIME!
Let’s not forget IV and V!I
DON’T
FORGET!
Instructor’s RecommendationI have personally instructed the applicant and consider this person ready to take the test.
Date Certificate No: Certificate Expires
INSTRUCTOR’SRECOMMENDATION
Instructor’s Signature (Print Name & Sign)
DESIGNATED EXAMINER’S REPORT
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )
Certificate or Rating for Which Tested
Date
Type(s) of Aircraft Used
Certificate No.
Registration No.(s)
Duration of TestGround Flight
Designation No. Designation Expires
Evaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Oral
Approved Simulator/Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Simulator/FTD
Advanced Qualification Program
Designated Examiner or Airman Certification Representative Report
Signature and Certificate Number
Examiner’s Signature (Print Name & Sign)
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )
Certificate or Rating for Which Tested
Date
Type(s) of Aircraft Used
Certificate No.
Registration No.(s)
Duration of TestGround Flight
Designation No. Designation Expires
OralApproved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Advanced Qualification Program
DESIGNATED EXAMINER’S REPORT
Designated Examiner or Airman Certification Representative Report
Evaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Examiner’s Signature (Print Name & Sign)
Signature and Certificate Number
Simulator/FTD
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )
Certificate or Rating for Which Tested
Date
Type(s) of Aircraft Used
Certificate No.
Registration No.(s)
Duration of TestGround Flight
Designation No. Designation Expires
OralApproved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Advanced Qualification Program
‘I have personally reviewed … and certify…meets…requirements for FAR 61
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
Designated Examiner or Airman Certification Representative Report
Simulator/FTD
Examiner’s Signature (Print Name & Sign)
Signature and Certificate NumberEvaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )
Certificate or Rating for Which Tested
Date
Type(s) of Aircraft Used
Certificate No.
Registration No.(s)
Duration of TestGround Flight
Designation No.
OralApproved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Advanced Qualification Program
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
Designated Examiner or Airman Certification Representative Report
Simulator/FTD
Examiner’s Signature (Print Name & Sign)
Signature and Certificate NumberEvaluator’s Record (Use For ATP Certificate and/or Type Ratings)
“I have personally tested...in accordance with...procedures and standards...”
Designation Expires
“Location of Test (Facility, City, State”Facility=Airport Name
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Certificate or Rating for Which Tested
Date
Type(s) of Aircraft Used
Certificate No.
Registration No.(s)
Duration of TestGround Flight
Designation No.
OralApproved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Advanced Qualification Program
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
Designated Examiner or Airman Certification Representative Report
Simulator/FTD
Examiner’s Signature (Print Name & Sign)
Signature and Certificate NumberEvaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Location of Test ( Facility, City, State )
Designation Expires
“Test Duration (Gnd / Sim/FTD / Aircraft), Cert or Rating, Type Aircraft, N#!
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )
Certificate or Rating for Which Tested
Date
Type(s) of Aircraft Used
Certificate No.
Registration No.(s)
Designation No.
OralApproved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Advanced Qualification Program
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
Designated Examiner or Airman Certification Representative Report
Simulator/FTD
Examiner’s Signature (Print Name & Sign)
Signature and Certificate NumberEvaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Duration of TestGround Flight
Designation Expires
BE COMPLETE AND EXACT IN THETYPE OF TEST GIVEN
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )
Date Certificate No.
Duration of TestGround Flight
Designation No.
OralApproved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Advanced Qualification Program
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
Designated Examiner or Airman Certification Representative Report
Simulator/FTD
Examiner’s Signature (Print Name & Sign)
Signature and Certificate NumberEvaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Certificate or Rating for Which Tested Type(s) of Aircraft Used Registration No.(s)
Designation Expires
“Date” -- This is ALWAYS the date of completion of the Practical Test!
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State ) Duration of TestGround Flight
OralApproved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Date
Advanced Qualification Program
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
Designated Examiner or Airman Certification Representative Report
Simulator/FTD
Signature and Certificate NumberEvaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Certificate or Rating for Which Tested Type(s) of Aircraft Used Registration No.(s)
Date Certificate No. Designation No.Examiner’s Signature (Print Name & Sign) Designation Expires
ATP/TYPE RATING - COMPLETE BOTH SECTIONS
Student Pilot Certificate Issued ( Copy attached )
I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirementsof 14 CFR Part 61 for the certificate or rating sought.
I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.
I have personally tested and/or verified this applicant or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.
Approved--Temporary Certificate Issued ( Original Attached )Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )
Certificate or Rating for Which Tested
Date Examiner’s Signature (Print Name & Sign)
Type(s) of Aircraft Used
Certificate No.
Registration No.(s)
Duration of TestGround Flight
Designation No. Designation Expires
Evaluator’s Record (Use For ATP Certificate and/or Type Ratings)
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Inspector Examiner Signature and Certificate Number Date
Simulator/FTD
Advanced Qualification Program
Designated Examiner or Airman Certification Representative Report
INSPECTOR’S SIGNATURE
ORIGINAL CFI APPLICATIONS
Student Pilot Certificate ( copy )
Knowledge Test Report
Temporary Airman Certificate
Airman’s Identification ( ID ) ID:Name:
Date of Birth:
Certificate Number:
E-mail Address
Attachments:
X
X
PENNSYLVANIA DRIVER’S LICENSE
271346273
12-13-2000
ATTACHMENTS
Notice of Disapproval
Superseded Airman Certificate
X
Form of ID
Number
Expiration Date
X Telephone Number940-484-9082
FAA Form 8710-1 (4-00) Supersedes Previous Edition NSN: 0052-00-682-5007 U.S.GPO:2000 520-137/95006
05-15-2000 05-31-2002
1. PASSENGER CARRYING IS PROHIBITED
CERTIFICATE NO.
ZZ-174727UNITED STATES OF AMERICA
DEPARTMENT OF TRANSPORTATIONFEDERAL AVIATION ADMINISTRATION
STUDENT PILOT CERTIFICATETHIS CERTIFIES THAT ( Full name and address )
ZIP CODE
BIRTH DATE HEIGHT
IN
WEIGHT HAIR EYES SEX
Has met the standards prescribed in Part 61 of the Fed-eral Aviation Regulations for a Student Pilot Certificate.
ISSUANCE DATE EXPIRATION DATE
SIGNATURE OF EXAMINER OR INSPECTOR EXAM. DESIG. NO. OR INSPECTOR’S
REG. NO.
DATE EXAMINER’S DESIG. EXPIRES:
STUDENT PILOT’SSIGNATURE
FAA Form 8710-2 (2-77) FORMERLY FAA FORM 8420-1
JETHRO BODINE3211 RODEO DRIVEBEVERLY HILLS, CA 96002
WILEY E. POST SW-05-28
03-31-2001
Jethro Bodine
07-16-1950 76 200 BLACK BLUE M
Wiley E Post
I. UNITED STATES OF AMERICADEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
TEMPORARY AIRMAN CERTIFICATEii .
III. CERTIFICATE NO.
THIS CERTIFIES THAT IV.
V.
DATE OF BIRTH HEIGHT
IN.
WEIGHT HAIR EYES SEX NATIONALITY VI.
IX. has been found properly qualified and is hereby authorized in accordance with the conditions of issuanceon the reverse of this certificate to exercise the privileges of
RATINGS AND LIMITATIONS
XII .
XIII .
THIS IS AN ORIGINAL ISSUANCE A REISSUANCEOF THIS GRADE OF CERTIFICATE
DATE OF SUPERSEDED AIRMAN CERTIFICATE
X. DATE OF ISSUANCE X. SIGNATURE OF EXAMINER OF INSPECTOR
EXAMINER’S DESIGNATION NO. OR INSPECTOR’S REG. NO.
DATE DESIGNATION EXPIRES
USE PREVIOUS EDITIONFAA FORM 8060-4 (8-79)
BY DIRECTION OF THE ADMINISTRATOR
284439812
ELAINE SUSAN OLEKSA419 SECOND STREETLOWELL, CT 01610
09-03-1946 68 126 BROWN BLUE F USA
07-16-1998
06-20-2000 WILEY E. POST 03-31-2001
RECREATIONAL PILOT
ROTORCRAFT - GYROPLANE
X
HOLDER DOES NOT MEET ICAO REQUIREMENTS
Wiley E PostSW-05-28 / 255124567
I. UNITED STATES OF AMERICADEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION
TEMPORARY AIRMAN CERTIFICATEii .
III. CERTIFICATE NO.
THIS CERTIFIES THAT IV.
V.
DATE OF BIRTH HEIGHT
IN.
WEIGHT HAIR EYES SEX NATIONALITY VI.
IX. has been found properly qualified and is hereby authorized in accordance with the conditions of issuanceon the reverse of this certificate to exercise the privileges of
RATINGS AND LIMITATIONS
XII .
XIII .
THIS IS AN ORIGINAL ISSUANCE A REISSUANCEOF THIS GRADE OF CERTIFICATE
DATE OF SUPERSEDED AIRMAN CERTIFICATE
X. DATE OF ISSUANCE X. SIGNATURE OF EXAMINER OF INSPECTOR
EXAMINER’S DESIGNATION NO. OR INSPECTOR’S REG. NO.
DATE DESIGNATION EXPIRES
USE PREVIOUS EDITIONFAA FORM 8060-4 (8-79)
BY DIRECTION OF THE ADMINISTRATOR
173239702
LOIS ANN GARNER123 NORTH SECOND STREETKIDD, PA 16236
07-27-1960 70 135 BROWN BROWN F USA
07-16-1997
03-31-2001
SW-05-28
PRIVATE PILOT
AIRPLANE SINGLE ENGINE LAND
X
RECREATIONAL PRIVILEGESROTORCRAFT - HELICOPTER
06-11-2000 WILEY E. POSTWiley E Post
2234167
61.75U. S. CERTIFICATE
COMBINE
FOREIGN BASED CERTIFICATE
Home Site Map DOT AskSearch
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Registry
The Federal Aviation Administration’s (FAA’s) Civil Registration (AFS-700) is responsible for developing, maintaining, and operating national programs for the registration of United States civil aircraft certification of airmen.
The Registry’s Aircraft Registration Branch (AFS-750) issues approximately 70,000 aircraft registration certificates and processes approximately 225,000 documents affecting title to or interest in aircraft engines, propellers, and air carrier spare part locations annually. Registry reserves and assigns all U.S. civil aircraft.
The Registry maintains the permanent records of over
Civil Aviation RegistryOnline N-Number Reservation Renewal
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FAQ
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RegistryAirmen Certification
General Airmen Certification Information:
PLEASE NOTE:
We are currently processing permanent Airmen Certificates with an approximate issue date of September 25th, 2003.
Customer Service:
ON-LINE SERVICES (establish your account, change your address
Interactive Airmen Inquiry Web Site
Hours of Operation
Change Releasability Status of your Mailing Address
Application for Replacement of Lost, Destroyed, or Paper Airman Certificate(s) and Knowledge Test Report(s)
Copy of Your Airman Certification Records
Update Your Address with FAA
Replacement of Your Lost or Destroyed Knowledge Test Report
Report a Change in Your Name, Nationality/Citizenship, Gender, or
Verification of Authenticity of Foreign License, Rating, and Medical
Effective July 23, 2002, persons applying for a certificate issued on the basis of a foreign license under the provisions of 14 CFR Part 61, Section 61.75, special purpose pilot authorizations under Section 61.77, using a pilot certificate issued under Section 61.75 to apply for a commercial pilot certificate under Section 61.123 (h), applying for an airline transport pilot certificate issued under Section 61.153 (d) (3), and applying for a certificate issued on the basis of a foreign license under the provisions of 14 CFR Part 63, Sections 63.23 and 63.42, must have the validity and currency of the foreign license and medical certificate or endorsement verified by the Civil Aviation Authority (CAA) that issued those certificates, before making application for an FAA certificate or authorization.
Please submit the required information using the optional FORM. Send the completed form with the preferred documents to the Airmen Certification Branch, AFS-760, PO BOX 25082, Oklahoma City, OK 73125-0082 or fax the form and documents to (405) 954-9922. The pre-application documents cannot be sent electronically.
A person who is applying for a U.S. pilot certificate/rating on the basis of a foreign pilot license must apply for that pilot certificate at least 90 days before arriving at the designated FAA FSDO where the applicant intends to receive the U.S. pilot certificate. This initial application step is the responsibility of the applicantThe information submitted to the Airman Certification Branch by the applicant must include the following information:
a. The name and date of birth of the applicant.
Verification of Authenticity of Foreign License,Rating, and Medical Certificate
CONTINUE TO CHECK THE WEB SITE
AND WITH YOU LOCAL FSDO FOR
NEW GUIDANCE REGARDING FLIGHT
TRAINING AND CERTIFICATION OF
FOREIGN PILOTS
SEND PAPERWORK TOFSDO WITHIN 5 DAYS!
?????????
That’s all folks!