Registration Form for Primary Pilots

Office Use Only Registration Fee ______Banner Fee ______Insurance ______Banner # ______

2016 NATIONAL BALLOON CLASSIC REGISTRATION – PRIMARY PILOTS  Required 35 PIC hours after receiving Private License  Registration space limited to 100 pilots (subject to change without notice)  20 spaces reserved for commercial pilots flying banners for the National Balloon Classic All entries must be completed. Please print clearly.

Name: Click here to enter text. Address: Click here to enter text. City: Click here to enter text. State: Click here to enter text. Zip: Click here to enter text. Phone: Click here to enter text. Email: Click here to enter text.

DATES ATTENDING THE NATIONAL BALLOON CLASSIC (PLEASE CHECK ALL THAT APPLY) ☐ Friday, July 29 ☐ Saturday, July 30 ☐ Sunday, July 31 ☐ Monday, August 1 ☐ Tuesday, August 2 ☐ Wednesday, August 3 ☐ Thursday, August 4 ☐ Friday, August 5 ☐ Saturday, August 6

REGISTRATION DEADLINE MAY 15, 2016 – Registrations received after this date are subject to additional fees Primary Pilots Who Register By May 15, 2016:  Registration fee: $150 nonrefundable + $25 basket banner/baggie deposit (new pilots only)  Receive Housing Stipend (pilots must reside outside Warren County)  Receive Pilot Gift  Balloon featured in 2016 National Balloon Classic Program Primary Pilots Who Register after May 15, 2016:  Registration fee: $200 nonrefundable + $25 basket banner/baggie deposit (new pilots only) Primary Pilots who register after June 15, 2016:  Registration fee: $250 nonrefundable + $25 basket banner/baggie deposit (new pilots only)

By registering, I agree to provide a minimum of one (1) sponsor ride, participate in a minimum of one (1) Nite Glow, and one (1) Candle Glow (if scheduled) during the 2016 National Balloon Classic. All banners remain the property of the National Balloon Classic. Banners must be returned to the National Balloon Classic at the conclusion of the event. I give the National Balloon Classic the right to use my name, balloon photograph, and any other information for apparel, marketing materials, or for use on websites and social media.

Signature: ______Date: Click here to enter a date.

2016 National Balloon Classic Primary Pilot Registration Page 1 This is not a hold harmless agreement. My aircraft is airworthy to fly in the 2016 National Balloon Classic.

I am aware of, and agree with the responsibility legally transferred to me under the FARs in regard to my personal decision to fly my balloon, and any bodily injury, and/or property damage resulting therefrom is my liability. I agree that none of the flights are mandatory and I will make all flights at my option, and my decisions as Pilot in Command (PIC) may affect my placement in this event should I choose not to fly. I agree to have in effect for the entire duration of this event a Balloon Liability Policy with Third Party Liability and Property Damage Liability Limits in an amount required by the National Balloon Classic. I agree the National Balloon Classic and sponsors of this event are providing me with the facilities and the means for my participation in this event, and in no way do they supersede the responsibility of the PIC as shown in the FARs. As PIC, I will thoroughly familiarize myself and my crew with all of the rules and the safety procedures published by the race organizers, and will abide by them. I will familiarize myself with the terrain and acceptable landing sites and local flying conditions associated with the event.

Signature: ______Date: Click here to enter a date.

PILOT INFORMATION

Pilot Name: Click here to enter text. Pilot Rating: Click here to enter text. Pilot License Number: Click here to enter text. Date of Last Flight Review: Click here to enter a date. (Complete prior to first day of Classic if needed) Total PIC Hours: Click here to enter text. (Required 35 PIC hours after receiving Private License) Note: Any Pilot with less than 75 PIC Hours must present a copy of pilot logs at registration

AIRCRAFT INFORMATION

Registered Owner: Click here to enter text. N#: Click here to enter text. Name of Balloon: Click here to enter text. (To be featured in promotional materials)

ENVELOPE INFORMATION

Make: Click here to enter text. Model: Click here to enter text. Date of last annual: Click here to enter text. Hours since last annual: Click here to enter text.

BASKET INFORMATION

Make: Click here to enter text. Model: Click here to enter text. Date of last annual: Click here to enter a date. Hours since last annual: Click here to enter text.

BALLOON INSURANCE INFORMATION

Insurance Company: Click here to enter text.

2016 National Balloon Classic Primary Pilot Registration Page 2 COMMERCIAL PILOTS ☐ Yes, I am interested in flying a banner for the National Balloon Classic ☐ No, I am not interested in flying a banner for the National Balloon Classic

DAWN PATROL ☐ Yes, I am interested in flying Dawn Patrol at the 2016 National Balloon Classic

BFA SANCTION The 2016 National Balloon Classic is host of the North Central Regional Championships

PILOTS NEEDING CREW ☐ No, I do not need crew any days during the National Balloon Classic. ☐ Yes, I need crew during the National Balloon Classic. If yes, how many crew members? Click here to enter text.

DATES/TIMES CREW IS NEEDED (PLEASE CHECK ALL THAT APPLY) ☐ Friday, July 29 pm only ☐ Saturday, July 30 ☐ am ☐ pm ☐ Sunday, July 31 ☐ am ☐ pm ☐ Monday, August 1 ☐ am ☐ pm ☐ Tuesday, August 2 ☐ am ☐ pm ☐ Wednesday, August 3 ☐ am ☐ pm ☐ Thursday, August 4 ☐ am ☐ pm ☐ Friday, August 5 ☐ am ☐ pm ☐ Saturday, August 6 ☐ am ☐ pm

MY T-SHIRT SIZE IS: Click here to enter text. (Unisex)

REGISTRATION DEADLINE MAY 15, 2016: Registrations received after this date are subject to additional fees

Please return completed forms and payment to: Becky Kakac, Office Manager National Balloon Classic PO Box 346 | Indianola, IA 50125 Fax: (515) 961-8416 Email: [email protected]

Faxing or emailing completed forms? Please call Becky Kakac at (515) 961-8415 with your credit card information when you register.

Questions? Please contact: Staci Scheurenbrand, Executive Director (515) 961-8415 [email protected] Bill Clemons, Race Director (641) 765-4770 [email protected] Becky Kakac, Office Manager/Pilot Housing (515) 961-8415 [email protected]

2016 National Balloon Classic Primary Pilot Registration Page 3