Birh Certificate by ozs91326

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									                                INDIVIDUAL REGISTRATION FORM
Surname: ______________________________________

First name : ____________________________________

Date of birh : ____________________________________

Address : __________________________________________________________________

Postal code : ___________________________ Town : ______________________________

Country : ___________________________________

Tel. (home) : ________________________           Tel. (office) : _________________________

Fax : (home) : _______________________           Fax : (office) _________________________

Email : _____________________________            Mobile : _____________________________

Occupation : ____________________________________

For foreign pilots :
Do you speak       French :            □Basic               □Average                     □Fluent
                   English :           □Basic               □Average                     □Fluent
If no, which ? _______________ :       □Basic               □Average                     □Fluent
Accommodation during your course :
North building :   □   single room               □   Double room               □ Multi-bedded room,
                                                                               Number of beds needed : ______
South building :   □   single room               □ Double room
Bungalow :         □
Camping :          □
Address and telephone number if you are staying outside the CNVV : ___________________________________________

Insurance :
N° of French federal licence : ___________________ Type : ________________ Date of expiry : ____________________
REMINDER :To glide at the CNVV (on CNVV gliders or non CNVV gliders) you must possess a valid French federal licence
(pilots and passengers). For foreign pilots, it is possible to obtain this licence at the CNVV. To glide on CNVV gliders, this
insurance is OBLIGATORY.

If you are gliding on a non-CNVV glider, please specify :

The name of your insurance Compagny : _________________________________________________________________

The number of your insurance policy : _______________________Contract expiry date : ___________________________

In case of accident :                 Blood group : ____________________________
Any special medical details : ____________________________________________________________________________
Person to contact :
Surname : __________________________________________ First name : ______________________________________

Address : ___________________________________________________________________________________________

Postal code : ________________ Town : ________________________________ Country : _________________________

Tel : _____________________________ Fax : ___________________________ E-mail : ___________________________

TO FILL IN ON THE DAY YOU ARRIVE :
Date of arrival : ___________________________________ Date of departure :
I hereby confirm that the details given on the registration form are exact and that il have read the CNVV rules and
regulations. I also agree to respect the “good gliding charter”.
Saint-Auban (date) ______________________ Signature :
Surname : ___________________________________________ First name : _____________________________________

Date of birth : ________________________

Type of course requested (see brochure or www.cnvv.net)
Type of course :                                Date :
□ Advanced piloting                             □ Mountain discovery flights
□ Advanced mountain flying                      □ Training                           □ Cross-country gliding
□ Aerobatic                                     □ Group (give the name of the leader) :
Glider to be used during course :
□ CNVV glider :
□ Other – type : _____________________ Registration : ______________________ Contest n° : ____________________
          If you are a member of a group, name of this group : _________________________________________________

Aeronautical references :

N° of glider pilot liecnce : _________________________ Date of expiry : _________________ issued on : ______________

Instructors n° : _________________________ Date of expiry : ____________________ Issued on : __________________

Date of authorization     Cross-country : _______________________ passengers : ________________________________

Silver certificate dated : ______________________________

Date of 300 km fixed : __________________ Date of diamond certificate, 500 km : ___________________________

Number of outlandings : ________________________________ In the past 24 months : ________________________

Gliders usally used : ______________________________________________________________________________

Total n° of gliding hours :                               As Instructor    First pilot     As trainee          Total

In the last 12 months

Total :

In mountain areas


Other experience in aeronautical activities :

___________________________________________________________________________________________________
___________________________________________________________________________________________________
Courses followed in Saint-Auban :

Type of course :                                Dates :                    Results, course assessment :

__________________________________              ____________________       ______________________________


Other courses followed in mountain areas (dates and places) :

___________________________________________________________________________________________________
This registration form must be send to :

                                            CENTRE NATIONAL DE VOL A VOILE
                                                        Aérodrome
                                            04600 SAINT AUBAN SUR DURANCE

								
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