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AIRBORNE SYSTEMS STUDENT REGISTRATION
Family Name: ___________________________________________________________
First Name: ______________________________Middle Name: __________________
Address: __________________________________________________________________________
__________________________________________________________________________
City: _____________________________________ Postal Code: _____________________________
Providence/Territory: _________________ Country: ___________________________
Country of Birth: ___________________ Country of Citizenship: _________________
City of Birth: _____________________ Anticipated Arrival Date: _______________
Date of Birth:________________ Anticipated Departure Date: ____________
Month / Day / Year
Training Courses Requested:
Private ___ Instrument ___ Commercial ___ Multi Engine_____ CFI ____ CFII _____
MEI ___ ATP ___ Phone: _________________ Email: _____________________
Payment: Please include a deposit of ___$2,000___U.S. dollars to be used toward the flight training course. If you are requesting a Certificate of Eligibility for a Non Immigrant Student (M-1 Student Visa) and you are not approved for the visa for any reason all monies will promptly be refunded to you minus the $600 application fee. Our Wire information is: Bank of America Ft. Lauderdale, Florida USA ACH/RT 063100277 Account #003603936418
Check Enclosed _____ Money order enclosed_____ Wire Transfer _______________
Charge Credit Card: Type______ Name on Card_______________________________
Credit Card Number ____________________ Expiration Date: ____________________
Student Signature: ___________________________ Date: ________________________
Airborne Systems, Inc.
Ft Lauderdale Executive Airport
2011 S Perimeter Road, Suite G/H Ft Lauderdale, Florida 33309
Phone 954-776-0543 Fax 954-776-0527