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Pilot Information Form
Indianapolis Aviation, Inc.
9913 Willowview Rd.
Fishers, IN 46038
Fields marked with an asterisk
*
are required
*
Name:
*
Work Phone:
*
Phone Number:
*
Address 1:
Address 2:
*
City:
*
State:
ZIP Code:
*
Pilot Certificate Number:
*
Date of Birth:
*
Medical Date:
*
Class of Medical:
1st
2nd
3rd
*
Last Flight Review:
*
Certificates:
Private
Commercial
ATP
CFI
CFII
MEI
Ratings:
Instrument
Multi-Engine
Endorsements:
High Performance
Complex
Tail Wheel
High Altitude
*
90 Day Current:
Yes
No
*
Night Current:
Yes
No
*
Instrument Current:
Yes
No
Not applicable
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