The Instructor is responsible for obtaining and discussing the following information with new customers. If the item is not applicable, write N/A.

Transcription

1 The Instructor is responsible for obtaining and discussing the following information with new customers. If the item is not applicable, write N/A. Items to Collect Things to Discuss Membership Application Discuss Club & Non-Club Rules and Regulations Zero Deductible Pilot Record Sky Scheduler Explanation Payment Authorization After Hours Procedures Copy of Credit/ Debit Card Copy of Drivers License Copy of Current Medical Copy of Birth Certificate or Passport Student Endorsements Flight Review Instructor Obtaining Documents: (Print) (Sign) (Date)

2 Membership Application Date of Application: MEMBER NON-MEMBER Please fill in the spaces below with the appropriate information. Last Name First, MI: Street Address: Street Address: City: State: Zip Code: Phone Number - Home: Work: Cell: Emergency Contact Info: Date of Birth: Present Employer: Years There: User Name: Password: How did you hear about us Flight History: Certificates Held (Circle Appropriate Ones): Airplane-Single Engine Land Multi Engine Land Student Private Commercial Instrument-Airplane Date Issued: Total Time: Last 90 Days: Briefly describe some aviation goals you would like to achieve at AAFC: Instructor Assigned:

3 I agree to and will: Rules and Regulations: 1. Pay, upon receipt of a bill from Aero Atlanta Flight Center all rental charges, and all other charges incurred by me, at the agreed upon or published rates. I understand that a charge of 10% of the billed amount will be charged on any past due amount. If collection of a past due bill is necessary, I agree to pay all collection costs, attorney fees and any and all other costs. 2. Return the aircraft, all tools, accessories and equipment, in the same condition as when received, ordinary wear and tear expected, to the place where the rental originated or any other location designated by a Club official, weather permitting, If forced to leave the aircraft elsewhere, I agree to arrange the return of the aircraft, at my own expense. SMOKING IS NOT PERMITTED IN ANY CLUB AIRCRAFT. 3. Notify Aero Atlanta Flight Center, in the event of undue delay, deviation or any other unexpected circumstances which do not permit my return of the aircraft at the designated time and will advise of my plans. 4. Operate the aircraft in accordance with all Federal, State, and Local Aviation Regulations, Laws, orders and ordinances and all rules, regulations, and operating instructions of Aero Atlanta Flight Center. 5. Act as Pilot in Command only if I have had a familiarization check-ride and ground review in the aircraft by an authorized Aero Atlanta Flight Center instructor and consider myself adequately informed to safely fly the aircraft. 6. Obtain weather reports and forecasts immediately before making a flight. I will not fly if conditions along my proposed route of flight and destination are reported or forecast to be below VFR minimums unless I have a valid Instrument Rating and have met the recency requirements and the aircraft has the proper instruments, which I have checked for accuracy before flight. 7. Prior to each flight I will file with Aero Atlanta a flight manifest for all flights and a FAA flight plan on ALL cross-country flights. 8. Land only at established airports except as a precautionary or emergency measure. 9. Inspect and make a ground check of the aircraft, its equipment, all accessories and comply with all check lists before taxi, takeoff and landing and will not operate said aircraft until I am satisfied as to its airworthiness and the proper functioning of all equipment and accessories. 10. Fly only from the left seat and will allow no one else to fly the aircraft, unless he/she is a flight instructor or pilot employed by or approved by Aero Atlanta Flight Center. 11. If I am a STUDENT PILOT, fly only under the direct supervision of, and with a logbook endorsement for each flight from a CFI employed by or approved by Aero Atlanta Flight Center. 12. Operate the aircraft in accordance within the parameters of good operating practices as set forth in the Pilots Operating Manual, the Airman s Information Manual, and the aircraft s Operating Instructions. 13. Not fly outside the boundaries of the Continental United States, unless I have written Permission from the President of Aero Atlanta Flight Center to fly a specific flight to locations outside the Continental United States. 14. NOT use the aircraft for hire or any commercial operation. 15. In the event of malfunction of any part of the aircraft or its accessories, I will not tamper with, molest, or attempt to repair, any part of the aircraft or its accessories: and will telephone Aero Atlanta Flight Center collect for instructions as to what actions to take. 16. Report all accidents and incidents, major or minor, to Aero Atlanta Flight Center as soon as possible, together with the names and addresses of witnesses and involved parties; and will not permit the aircraft be moved unless expressly authorized to do so by Aero Atlanta Flight Center and will take the necessary steps to protect the aircraft and its equipment from further loss. 17. Pay for any loss or damage to the aircraft or to persons or property caused in whole or in part by my failure to comply with the above, or by my negligence or pilot error, not covered by the insurance within 10 days of invoice be Aero Atlanta Flight Center. 18. Indemnify and hold Aero Atlanta Flight Center, the aircraft owner, or any of its agents harmless of, from and against any and all loss, costs, damages, attorney s fees and or liability including personal injury, death, or property damage claims arising from, or in any manner, occasioned by the operation or use of the aircraft whether such claim is asserted by the undersigned or by any other party. I assume all risks of such loss or damage and waive all claims against Aero Atlanta Flight Center and any of its agents. I agree to hold Aero Atlanta Flight Center, harmless from and to defend and indemnify Aero Atlanta Flight Center and any of its agents against all claims based upon or arising out of loss or damage. Initial:

4 19. I understand that fuel is reimbursed when a fuel receipt is presented, at a reimbursement rate not to exceed the current fuel prices paid at McCollum. I also understand fuel is reimbursable in the form of flight time only. 20. Pay for at least 1 hour of rental time for each complete weekday and 1 hour for each complete eight-hour period on a weekend day or legal holiday, even if the flight time on the aircraft is less for each day I have the aircraft. 21. Examine the Discrepancy Log and the Hobbs/Tach log prior to starting the engine. Starting the engine constitutes acceptance of the aircraft with the discrepancies and the ending Hobbs/Tach log as recorded from the previous flight. I further understand that I am renting aircraft from Aero Atlanta Flight Center and that no time is there any passage of title of any aircraft, in whole or in any part to me. I understand that the bill received from Aero Atlanta Flight Center for flight time, fuel damage, dues and any other expenses is payable upon invoice and agree to pay said bill at that time. I CERTIFY THAT I HAVE READ, UNDERSTAND AND WILL COMPLY WITH AND BE BOUND BY ALL OF THE TERMS AND CONDITIONS OF THIS AGREEMENT. DATE: SIGNATURE: ZERO-DEDUCTIBLE INSURANCE RELEASE AUTHORIZATION I, hereby request Aero Atlanta Flight Center to release me from the $5000 property liability that I may incur due to an accident with a Club aircraft. I understand that this release will not be in effect for gross pilot negligence. I further understand that this coverage shall be effective upon receipt of this form by Aero Atlanta Flight Center. If I am a renter and am receiving dual instruction from a club-approved instructor, I understand that I am responsible for covering the deductible if an accident occurs. Initial one of the below: I agree to pay the $250 insurance deposit refundable to me upon written cancellation of my membership. I also understand that this deposit is refundable only if my membership is in good standing with Aero Atlanta and I have been a member for a minimum of six months. I agree to pay Aero Atlanta Flight Center $5.00 per flight hour, which I understand will be added to my flight charges. Signed: Aero Atlanta Member/Renter Aero Atlanta Flight Center 1723 McCollum Parkway Kennesaw, GA

5 Payment Authorization Form Charges for all aircraft flights will be processed within one business day of the completion of that flight. All aircraft rental requires a credit card to be placed on file. Customers are welcome to pay Cash, Check, or use a different card at the time of flight completion. Otherwise, charges will be placed on the credit card on file. Visa Card # Master Card # Discover Card # Amex # Security Code (V/M/D - 3 digits on back/amex 4 digits on front) # Name as it appears on the card: I authorize Aero Atlanta Flight Center to charge my card for all outstanding charges on my account. I understand that this authorization shall be in effect until I notify Aero Atlanta Flight Center, Inc. of my intention to close my account in writing and have made full payment for any and all outstanding charges. Signature authorizing charges: PREPAYMENT OPTIONS (DISCOUNTED RATES) Aero Atlanta offers discounts to customers applying prepaid money on account in the following increments: Amount Purchased Discount $ $4000 4% $ $6000 5% $ % Increase discount amount by 1% for payment by Cash or Check. All American Express and Discover Card holders incur a 1% charge. All Block Purchases must be accomplished by swiping the desired card. Initial Block Amount Requested: Once the block amount is depleted, you will be contacted by Aero Atlanta Flight Center staff to purchase additional block purchase.

6 PILOT RECORD Pilot Name Pilot Certificates Now Held Address Student Private Commercial Date of Birth ATP Certificate Number Flight Instructor Occupation Recreational Employer FAA Pilot Ratings Now Held FAA MEDICAL CERTIFICATE ASEL SES Date Issued Class AMEL MES Waivers IFR Glider If none, write none Helicopter TRAINING AND REFRESHER TRAINING Other: Describe Simulator Describe Simulator Flight training Flight training Aircraft Type Aircraft Type School Date School Date Do you hold a current FSI Pro Card or Simuflite Card? Yes No Date of last Biennial Flight Review or equivalent. Do you participate in FAA Pilot Proficiency AwardProgram? Yes No LOGGED PILOT HOURS Hours Hours Hours Total Logged All Aircraft Multi-Engine Turbo-Propeller Tail Wheel Glider Amphibious Retractable Gear Helicopter Jet Seaplane Instructor Other Please explain fully any YES answers to the following questions on reverse side. 1. As pilot in command or co-pilot have you had or been involved in any aircraft accidents or incidents? No Yes 2. As pilot in command or co-pilot have you been found guilty of or been penalized, disciplined, fined or violated for any No Yes civil or military Air Regulations? 3. Has your automobile drivers license ever been suspended or revoked? No Yes 4. Have you ever been arrested for operating an automobile under the influence of alcohol or drugs? No Yes 5. Have you had any automobile accidents within the last five years? No Yes 6. Any aircraft / aviation insurance claims or losses? No Yes 7. Have you ever been convicted or pleaded guilty to a felony? No Yes 8. Has any insurer cancelled or declined to renew any aircraft insurance for you in the past five years? No Yes Remarks: I represent that the answers given are true and complete to the best of my knowledge and belief and that no material information has been withheld. Date Signed (Pilot s personal signature required)

7 After Hours Rental Procedures Departure: Until 8pm on any day of Flight: If no AAFC personnel available to assist you: If you require fuel, please see the Jet Center front desk and advise of fuel needs Complete manifest and checkout airplane in AAFC flight planning room Obtain aircraft book from behind AAFC front desk and leave manifest If there is a problem, please contact Ben Kroll at After 8pm Please advise AAFC of fuel needs prior to 5pm on day of flight The flight school and FBO will be closed The aircraft book/key will be placed in the aircraft for you You may access the ramp via the walk through gate under the FBO turnaround Arrival: Until 8pm on any day of flight Return book to AAFC If no AAFC personnel are present, leave book on front desk counter Place all fuel receipts in aircraft book If there are any aircraft discrepancies, please note them on Skyscheduler After 8pm: Leave aircraft book/key in airplane Place all fuel receipts inside the aircraft book You may exit the ramp via the walk through gate under the FBO turnaround If there are any aircraft discrepancies, please note them on Skyscheduler Please note: If you schedule an aircraft for a same day flight and are concerned about the aircraft being ready or the availability of AAFC personnel please call the front desk, or Ben Kroll to confirm. If you have a fuel receipt and need a copy for your own records, please let us know and we can either you a copy of the receipt or return the original to you after we have processed your flight. If you encounter any problems with accessing or checking out aircraft, please contact Ben Kroll at Please do not leave notes concerning aircraft/rental issues. Instead, either call the AAFC front desk and leave a message or ben.kroll@aeroatlanta.com. If you are unfamiliar with checkout, manifest, or discrepancy reporting, please let an AAFC instructor know so we can assist you.