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2005 CF World Record Team: Online Registration

Name:
(Please enter your name how you would like it to appear on the official record)		  
Mailing Address:
  Line 1:
  Line 2:
  State, Zip:
  Country:
 
 
 
,
 
Phone:
  Home:
  Work:
  Cell:
 
 
E-Mail Address:  
Number of Total Jumps:  
Number of Canopy Formation Jumps:  
Weight - without Gear / Naked:  
Wing Loading (Weight in pounds + all gear / Canopy size):  
Height:    
Number of Lightning canopies you can bring:  
Serial Numbers of Lightning canopies (with world record line trim)
   
   
 
T-Shirt Size:   S M L XL2X3X
DVD format:
  NTSC (US) PAL (Europe)
English Fluency - (Yes/No):   Yes No
Primary Language:  
USPA (or other skydiving assocation) Number:  
USPA (or other skydiving association) license Number:     
FAI Sporting License Number:  
FAI Expiration Date:
Next of Kin Contact Info:
  Name:
  Relationship:
  Address:
  Phone #, Cell # :
  E-Mail Address:
 
 
 
Credit Card Number:  
Expiration Date:  
3 digit CID from back of credit card  
Name On Card:  
Mailing Address for card:
  Street:
  City:
  State, Zip:
 
 
,
Arriving Orlando area via:   Car   /   Plane
Flight Date :
  Airline:
  Flight # :
  Arrival Time :
  Need ride from airport?:
  Will Rent a Car? :
 
 
 Yes   No
  Yes No
# Extra Banquet seats needed:   0 12 3 45