Pilots Registration Form - Village de Loubas

Entry Type*

Special Shape

Private

Commercial

Balloon Registration*

Balloon Manufacturer & Type

Balloon Volume

C of A Expiry Date

Please submit an image of your balloon with this registration form*

Insurance Company*

Insurance Policy Number

Insurance Expiry Date

Insurance CSL (Combined Single Limit)

Number of Pilots*

1

2

3+

Pilot 1 Name*

First

Last

Date of Birth

day

/

month

/

year

Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Email*

Mobile Phone

Medical Certificate Expiry Date

PPL/CPL Number

Total P1 Hours

Pilot 2 Name

First

Last

Pilot 2 Date of Birth

day

/

month

/

year

Pilot 2 Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Pilot 2 Email*

Pilot 2 Mobile Phone

Pilot 2 Medical Certificate Expiry Date

Pilot 2 PPL/CPL Number

Total P2 Hours

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Please Email us separately if you wish to fly commercially

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