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Name and first name : *
Address : *
 
Phone number : *
Email : *
Club : *
Licence number : *
FAI 2012 licence number : *
Glider type : *
Class :
Handicap :
Mean of propulsion : *
Registration : *
Contest number : *
Insurance company : *
Police number : *
Airworthiness certificate Nbr : *
Validity : *
1.Flight Recorder type :
1.Flight Recorder ID :
2.Flight Recorder type :
2.Flight Recorder ID :
Photo (portrait de 500 Ko Max) : *
Weight & Balance sheet (500 Ko Max) : *
   

I hereby certify I read, understood and will comply with the local rules of the Belgian National Championship 2012.*

   
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