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Name

First

Last

Gender

Date of birth

Height (feet/inches)

Weight (lbs)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

of your Birth

Passport number

Birth country

Citizenship

City of birth

What is your proficiency in the English Language (0 none, 10 perfect)

Selected Value: 0

Next of kin (Name, address, phone, email)

Emergency contact (name, address, phone, email)

Which course are you enrolling on

Course cost you have been quoted

How do you intend to fund your training?

What medical do you hold?

Proposed start year/month

Proposed finish year/month

Do you require accommodation?

Enter total hours flown, total PIC, total night, licences held etc.

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