Crew Pilot Training Application & Training Agreement
Click here for a printable version of this form
FIRST NAME: LAST NAME: DATE OF BIRTH:
SOCIAL SECURITY NUMBER:
ADDRESS:
CITY: STATE: ZIP: -

PHONE: (H)

PHONE: (W)
CELL PHONE: E-MAIL:

FLIGHT TIME INFORMATION
FAA LICENSE: (ATP) (COMMERCIAL) LICENSE #:
AIRCRAFT TYPE RATINGS:
TOTAL FLIGHT HOURS: = TOTAL PILOT IN COMMAND (PIC) + TOTAL SECOND IN COMMAND (SIC)
MULTI-ENGINE LAND (MEL) TURBINE TIME: TYPE AIRCRAFT CURRENTLY FLYING:
MEL AIRCRAFT FLOWN:
DATE OF LAST FLIGHT PHYSICAL : CLASS: (If applying for VA benefits must be VALID First Class physical)
CURRENT EMPLOYER: REFERRED BY:
PREFERRED CLASS DATE: OPTIONAL DAYS FOR THE REMAINDER OF THE MONTH OF THE PRIMARY DATE (ex.: 12, 14, 19, 23):
(CPT starts classes normally on Mondays)  
Southwest course estimate: $7,300.00
VA Student yes no
TRAINING AGREEMENT
Trainees agree to indemnify, defend and hold harmless Crew Pilot Training & Equipment contractor, its directors, officers, employees, agents, and representatives from and against all claims, liability, loss, or expense (including legal fees, court costs, and other costs and expenses arising out of or in connection with this Agreement and including, but not limited to, claims of Licensee its employees or trainees or claims of any other party arising out of injury to or death of any person or damage to or destruction of the property or any person or entity, including property of Crew Pilot Training and the Equipment Contractor.) I have read and agree to all Crew Pilot Training change of class date, cancellation fees and regulations listed on our website (www.crewpilottraining.com) and our information packet. The trainee agrees to pay all cost coverages, (if any), from the listed program estimate.
By checking this box I agree to the terms and agreement