Russell Aviation Training Application Updated 11.11.10 Mailing Address: P.O. Box 1553 Buena Vista Colorado – 81211 719-207-8760 email: email@example.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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