Aerospace Education

The Ninety-Nines, East Canada Section
Annual Proficiency Training Program Form

Everyone, please return to your Chapter Coordinator/Chairman, as APT Trophy is awarded from % of eligible members.

(   ) Yes, I am A.P.T.           (   ) No., I am not eligible.        Year: ____________

NAME: _____________________________ LICENCE TYPE & NO.:_________

(note previous name, if applicable)

ADDRESS: __________________________ _______________________________

RATINGS: __________________________________________________________

Chapter: _____________________     MEDICAL CLASS & DATE: ______________

Section ___________________________ (State previous Chapter, if applicable)

Declaration:

I declare  that  I am  A.P.T.  (check at least one space in both A & B below)

 ____________

A.

New Licence (   );

New or Renewed Rating (   );

Currency Flight (   )

 B. Licences:

Recreational (   ); Private (   );

Commercial (   );

ATPL (   );

Glider (   );

Helicopter (   );

Balloon (   );

Other (   );

(specify: )

 Ratings/Endorsements:

Instrument (   );

Instructor (   );

(Class: ____)

Multi-engine (   );

Night (   )

Aerobatic (   );

Seaplane (   );

Glider Tow (   );

DFTE (   )

Check Ride for insurance purposes (   )

Checked out on advanced aircraft (   )

Mail the completed form to your  APT Co-ordinator

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