Pilot Sign-up

MARCO POLO RALLY
ENTRY FORM

Please re-submit your registration here, if any contact details have changed, or you are planning to use a different aircraft, or wish to cancel. Thank you!

Pilot Information

Mr./Mrs/Ms.

Title

First Name

Last Name

Street Address

City

State / Province

Zip

Country

E-Mail

Telephone

Fax

My web site URL

I have flying hours
Preferred flying dates
Long range / air race experience
Memberships (Aeronautics) Clubs, Organizations
in country/state
Occupation
Age
Nationality
Other Interests

Navigator and/or
Rally Crew Information (where applicable)
For multiple entries, please resend this form.

Mr./Mrs/Ms

Title

First Name

Last Name

Street Address

City

State / Province

Zip

Country

E-Mail

Telephone

Fax

Please specify function(s): Air -, ground support, etc.

Aircraft

Country of Registry

Make
Model
Year
Type Specifications*

pfw = powered fixed wing ppw = powered para wing
pws = powered weight shift rtw = rotor wing

Aircraft Serial Number
Registration/Identification Number / VIN

Engine Type and HP
Engine Serial Number

Empty Weight (Kg)
Max Fuel (Litres)

Full Power Flight Speed (kts)
Power Off Stall Speed (kts)
Estimated rally speed

Estimated daily distance in Km

"Certificate of Airworthiness"
"Permit to Fly", or other Ultralight operating exemption from your countries' Civil Aviation Authority

Date of issue / date of expiry

Certification of Medical Status and Compliance

I hereby certify that I have no known medical condition or physical defect, which would make my operation of an ultralight vehicle unsafe. I also certify that should such a condition come to my knowledge, I will inform the organizers.

Comments

The moment we finalize the detailed rally conditions, we shall require copies of your copies of pilot, vehicle registration, and medical certificates, airframe and engine logs, operating limitations, weight and balance data, and a Certificate of 3rd Party legal liability insurance valid for the aircraft to be flown. We may refuse to accept any application for entry if we believe such entry is not in the best interests of the race.

Until then, I thank you for your kind co-operation!

Please also send information to (name and e-mail address):

Aeronautics Club, Organization
My friends
My business associate

It is understood that your data shall be treated confidentially, and used for organizational purposes only.

Problems signing up ? Please report errors to mpr[at]wst.nu

"Whatever you do, or dream you can, begin it.
Boldness has genius, power and magic in it."
- Johann Wolfgang von Goethe