STUDENT

REGISTRATION

FORM

STUDENT REGISTRATION FORM

Please Complete this Form to Get Started!

Please Complete This Form, So That We Can Provide You With The Best Information In Response To Your Inquiry.

Complete only those fields for which you have information.

CONTACT INFORMATION:

First Name *

Last Name *

Date of birth *

Mobile Phone # *

Email Address *

Address *

City *

Province *

Postal code

Country *

EMERGENCY CONTACT INFORMATION:

Emergency Contact - Full Name *

Emergency Contact - Phone Number *

Emergency Contact - Relationship *

TRAINING INFORMATION:

Training Location *

PAYMENT INFORMATION:

Method of Payment *

eTransfer - [email protected]

Cheque - Payable to Aurora Aviation Academy

Credit Card Prepayment (3% Credit Card Fee Applies)

Cash

Direct Deposit or Bank Transfer

Wire Transfer (Wire Transfer Fees may apply)

Other

AVIATION MEDICAL INFORMATION:

Aviation Medical Class Held

Class 1 - Required for Commercial & Above

Class 3 - Minimum required for Private & Recreational

Date of Last Aviation Medical Examination

Aviation Medical Expiry Date

PILOT INFORMATION:

Pilot Licence Number

Pilot Licence - Country of Issue

Pilot Licence - Date of Issue

Pilot Hours - Total

Date of Last Flight

DRIVER'S LICENCE INFORMATION:

Driver's Licence - Number

Driver's Licence - Province of Issue

Driver's Licence - Expiry Date

PASSPORT INFORMATION:

Passport - Number

Passport - Country of Issue

Passport - Date of Issue

Passport - Expiry Date

Certification of Information

I certify that the information provided above is accurate to the best of my knowledge, at the time of submission of this Student Registration Form. If any of the above information changes, I will notify Aurora Aviation Academy of such changes within 5 business days.

I hereby acknowledge that I have read, understood and will comply with the Aurora Aviation Academy - Rates & Policies Document.

SIGNATURE of STUDENT or LEGAL GUARDIAN if the Student is under 18 years of age:

Student Signature

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Contact Information

Email us at:

[email protected]

Mail us at:

6200 Tronson Road

Vernon, BC, Canada, V1H 1N5

STUDENT REGISTRATION FORM

Please Complete this Form to Get Started!

Contact Information

Email us at:

[email protected]

Mail us at:

6200 Tronson Road

Call us at:

1.888.365.3311

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