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									                         Russell Aviation Training Application
                                         Updated 11.11.10

                             Mailing Address: P.O. Box 1553
                              Buena Vista Colorado – 81211
                                       719-207-8760
                             email: russellaviation@msn.com

FLIGHT TRAINING APPLICATION FOR: ______________________________________
                                   PRINT YOUR FULL NAME

Please print this application form, complete and sign it, then return to us by surface mail. It is
important that you complete all of the information so that we can serve you best.

    A course registration deposit payment is due with this application to hold your
    training date. Full payment is due 30 days prior to your training start date.

    Payment Enclosed:

    US certified funds only. No personal checks within 5 days off training start date.

    Name on Check: __________________Check #________ Amount: $_____________

                      The $1,500 deposit is required with this application.

       If training start date is within 30 days of payment – then the full amount is due
                                         with application.

Select Course Below:

  Select Course Description                                                       Course Fee

           Private Pilot Training Adventure: Your Aircraft                        $ 6,250
           Instrument Adventure Course: Your Aircraft                             $ 4,900
PERSONAL DATA:

Name________________________________________________________________________

Address_______________________________________________________________________

City _______________________________________State____________________

Postal Code/Zip ____________________________________________________

Country_____________________________ Date Of Birth _______________________

Height _______' _______" Weight __________ pounds (must have to determine aircraft needed)

Current Profession or Occupation: ____________________________________________

Email Address____________________________________________________________

Home Phone_________________________ Cell Phone___________________________

Work Phone___________________________ FAX:___________________________________

Emergency Contact Name_______________________________________________________

Emergency Contact Phone Number_________________________________________________

Desired Training Dates: First Choice _______________Second Choice_____________________

Arrival Date____________ Airline______________ Flight Number________________________

Departure Date____________ Airline___________ Flight Number________________________

Do you have a current US Passport ____ Yes ___ No (Required to have 20 days before
scheduled start date or a certified Birth Certificate)

Do you have a previous TSA endorsement ____Yes ____No – If Yes then enter date: _________

CAR RENTAL DESIRED:

Yes____ Indicate size______________ or No thanks, I will arrange my own transportation______

LODGING ACCOMMODATIONS WHILE IN TRAINING:

No Lodging (I’ll make my own reservations) ______

Smoking or Non-Smoking Room___________________ One Bed or Two Beds____________

Other Special Requests________________________________________________________
AERONAUTICAL EXPERIENCE DATA

FAA Medical Certificate?_________ Class___________ Date Issued______________________

Total Flight Hours_____________ Aircraft Owned__________________ Tail #_______________

Total Hood Time ________ Total Simulator Time _________ PIC ________ X/C Time ________

Private Pilot Written Test Passed?_____________ Date Passed____________ Score_________

Instrument Written Test Passed?______________ Date Passed____________ Score_________

STUDENT AIRCRAFT USE

_______   I understand that I must supply an aircraft for training.

Make and Model ________________________________ Reg. Number __________________

Russell Aviation assumes no responsibility if student’s own aircraft does not meet acceptable
standards for the FAA Practical Test. It is the student’s responsibility to determine if all aircraft
logs and maintenance records are up to date and meet FAA requirements. Every reasonable
effort will be made to provide parking space for your aircraft during your training either on location
or at our partnering FBO’s or flight schools ramp area, however no guarantees are implied for
ramp space. Fuel, oil and some light maintenance may be obtained at market prices if needed.
REMEMBER TO BRING YOUR AIRCRAFT LOGBOOKS!!

TERMS AND CONDITIONS:

It must be noted here that our training courses are not pre-paid packages. A $1,500 deposit is
required with this application. Should you cancel less than 45 days from your stated arrival date,
Russell Aviation will not refund any payments made, unless trainee schedules a new training date
and pays a $495.00 rescheduling fee within 10 business days of cancellation request.

All fees and payments must be made 30 days before training date. If full payment is not made 30
days before your training start date, you could lose your deposit and you do not have a
guaranteed training date. Russell Aviation accepts payments via wire transfers, certified funds
and cash. We can accept personal checks up to 5 business days before your training starts. We
cannot accept personal checks for payment after 5 business days before your training date or
after your arrival date. If Russell Aviation has to cancel your Training Adventure for any reason
before your training date, all payments will be refunded in full, including the initial deposit. Your
canceled check will be your receipt.

The courses are designed to be completed within the stated amount; however, circumstances
beyond our control and/or your control could prevent you from completing the course in the
specified time. These circumstances may include, but are not limited to: adverse weather,
equipment failure, illness, acts of terrorism and the student’s own limitations. In the case of a
training course not completed in the specified time, the student may elect to extend training until
completed or return within 45 days to finish the course.
To complete our accelerated course in the allotted time, each lesson must be completed on the
first attempt. The training and hours received up to that point could still count toward your
certificate or rating, even if you elect to finish your training at another facility.

Completion of my training course does not guarantee that your instructor(s) will endorse you for a
written test, practical test or solo privileges. The decision to provide such endorsements is strictly
at the discretion of my flight instructor(s).

Identification documents required and Foreign Students: All U.S.A. students must provide a
valid Passport or original birth certificate before training can begin. Also, students training for the
Private Pilot must have at least a 3rd class medical before arriving for training. All foreign
students will have to pass a United States Transportation and Security Administration “TSA”
background check. Due to the extra time involved for this process, Russell Aviation will be
charging a fee of $950.00 for this service.

NOT INCLUDED IN OUR COURSE Aircraft(if student has selected to provide aircraft), fuel,
student meals, rental cars, taxis, laundry, tips, headsets, books, maps, charts, approach plates,
examiner fees, and any personal costs such as telephone calls, souvenirs, custom fees,
landing/facility fees, etc. Lodging is not included; student will pay their own lodging costs plus cost
of instructor lodging while instructor is away from Buena Vista Colorado. Round trip airfare cost
for instructor to come to your location for your training is not included in price.

ADDITIONAL COSTS: Students that have not taken their written exam can either take the exam
the day before their flight training starts or plan on 1-2 additional days and paying an additional
$485.00 per day for ground training to prepare for the FAA Written Exam. You must schedule any
extra days for written exam training before your flight training start date. If you do not meet our
training requirements when you arrive, additional cost will be incurred.

Any additional flight hours or instruction after your scheduled training dates or times will generate
additional cost per hour for aircraft. Instruction is billed at $485.00 per day for training (6 hours
max – per day) if extra training is needed. Student will need to make final and/or advance
payment of any outstanding balance before receiving their practical test sign-off.

Temperature restrictions: We do not fly if the outside temperature is below 20 degrees F or
above 100 degrees F.

RESPONSIBILITY: "Russell Aviation LLC" and/or its agents act solely as booking agents for the
hotels, car rental, transportation companies, flight schools, flight instructors, testing centers and
any other service in connection with the itineraries of individual, pilot crews, and students in flight
training. Reservations are made and accepted under the terms and conditions of each individual
supplier. "Russell Aviation LLC" and its suppliers shall not be liable for any damage, loss,
accident, injury, delay or irregularity, liability or expense to person or property due to an act or
default by any hotel, carrier, flight school, instructor, or other company or person providing service
included in the itinerary or training schedule. All lodging will be selected by Russell Aviation or
one of its agents. If student wishes to have different lodging accommodations than those selected
or provided by Russell Aviation, lodging cost will be paid by student and no refunds will be made.

In addition, "Russell Aviation LLC" and/or its agents accept no responsibility for any illness, theft,
labor disputes, machinery breakdown, government constraints, acts of war or terrorism, weather
conditions, acts of God, defect in any vehicle or transportation or for any misadventure or
casualty or any other courses beyond their control. The responsibility of any airline used is solely
set out in the passenger's contract as evidenced by the ticket. Airlines and other carriers are not
responsible for any act, omission or event during the time passengers are not aboard their planes
or conveyances. Russell Aviation does not make any refunds on airlines tickets or lodging bought
by student, even if your course is canceled for any reason.

Privacy Agreement: Russell Aviation LLC follows strict security standards and procedures to
help prevent unauthorized access to personal information, aircraft and airports. Only properly
authorized employees and/or agents of Russell Aviation may access information Russell Aviation
collects from or about customers. Instructors of or used by Russell Aviation who have access to
customer or consumer information may use it only for legitimate business purposes. Additionally,
Russell Aviation safeguards customer information in accordance with data security regulations,
including personal information received via the Internet. We may disclose information we collect
about our customers to government, regulatory and legal authorities in response to a subpoena,
to prevent acts of terrorism, or to comply with an inquiry by a government agency. We never give
out customer contact information to anyone requesting references.

Right to Refuse Service: Russell Aviation L.L.C. reserves the right to refuse service to anyone
at anytime who is not a U.S. Citizen, is found to be unsafe or disrespectful of Russell Aviation
staff or instructors. I understand that I must furnish a valid Passport or a certified Birth Certificate
and a current medical upon my arrival to start my training. I also must furnish the aircraft logbooks
for my aircraft is it is used for my practical flight test. If I do not have these documents/logbooks
with me upon my arrival, I understand that I will not be able to receive training and that no refunds
will be made in any of the above cases.

Disputes: In the unlikely event there is any dispute between the customer and Russell Aviation
that can not be resolved by both parties within 60 days, the parties will submit to mediation by a
mediator chosen by both parties and, if not resolved by mediation, then by binding arbitration by
one arbitrator chosen by the parties, or if no choice can be made, then by an arbitrator chosen by
federal judge for the district of Colorado. All proceedings shall occur in Denver, Colorado, and
Colorado law shall apply. The customer agrees to this exclusive jurisdiction and venue in
Colorado for resolving all disputes. In any case, any mediation or arbitration will commence within
one year of the execution of a signed contract by both parties.

By my signature below, I acknowledge my understanding of and agreement to all conditions
within this application.


_____________________________________________ Date__________
Signature
                                           About You
To help in our training, we would like to ask you a few questions that could help us in your training
and to get to know you a little better. You can leave this section blank if you like.

What are you hobbies: ______________________________________________________

_________________________________________________________________________

What are some of your interest: __________________________________________

____________________________________________________________________

What is you biggest concern about your training: ____________________________

____________________________________________________________________

Will you use you training for business, employment or private use: ______________

____________________________________________________________________

What was the best moment you ever had flying: _____________________________

____________________________________________________________________


Do you consider yourself an introvert or and extrovert: ________________________

What is your education level (please be detailed): _____________________________

_____________________________________________________________________

Any information you feel we should know that could help in your training: _________

_____________________________________________________________________


Thank you far taking the time to fill out this questionnaire. It will help us in your training.

Thank you again for selecting Russell Aviation for your training.

Best Regards,
Mickey Russell, President
Russell Aviation L.L.C.

								
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