Name:
(Please enter
your name how you would like it to appear on the official record) |
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Mailing
Address: |
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Line 1: |
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Line 2: |
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State, Zip: |
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Country: |
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| Number
of Canopy
Formation Jumps: |
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| Weight
-
without Gear / Naked: |
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| Wing
Loading
(Weight in pounds + all gear / Canopy size): |
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| Serial Number of Lightning canopy (with world record line
trim) |
| Date of Manufacture M/YY |
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| English
Fluency
- (Yes/No): |
|
Yes No |
| D-license
number (or other skydiving association equivalent) |
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| USPA
(or other skydiving association) membership number: |
|
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| FAI
Sporting License Number: |
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| FAI Expiration Date: |
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Next
of Kin Contact Info: |
| |
Name: |
| |
Relationship: |
| |
Address: |
| |
Phone #, Cell # :
|
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E-Mail
Address: |
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Mailing
Address for card: |
| |
Street: |
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City: |
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State,
Zip: |
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| Arriving
Orlando area via: |
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Car
/ Plane |
|
Flight
Date : |
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Airline: |
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Flight
# : |
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Arrival
Time : |
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Need
ride from airport?: |
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Will
Rent a Car? : |
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| #
Extra Banquet
seats needed: |
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0 12 3 45 |