SSA State Soaring Record Application Form

PILOT INFORMATION
* Required Fields
Pilot's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
SSA Member #*
Phone Number

Area CodePhone Number
Pilot's Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Crew's Name

First NameLast Name
Crew's Birth Date

MonthDayYear
Crew's Gender

MaleFemale
Crew SSA Member #
Crew's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Departure Date*

MonthDayYear
GMT Date
Departure Airport*
State in which the Start Point is located*
Aircraft Make & Model*
N#*
Sports Class Handicap
if applicable
Landing Site*
Landing State*
Landing Date*

MonthDayYear
GMT Date
DISTANCE CLAIMS
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Would you like to add more Distance Claims?

YesNo
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
Category: Class: Record Type: Distance:Statute Miles Actual/Handicapped
SPEED CLAIMS

Not all distances are available for each record type - See current rules
Category: Class: Record Type: Speed:MPH Actual/ Handicapped
Category: Class: Record Type: Speed:MPH Actual/ Handicapped
Category: Class: Record Type: Speed:MPH Actual/ Handicapped
Category: Class: Record Type: Speed:MPH Actual/ Handicapped
Category: Class: Record Type: Speed:MPH Actual/ Handicapped
Category: Class: Record Type: Speed:MPH Actual/ Handicapped
Start Time (GMT)
Finish Time (GMT)
Elapsed Time
ALTITUDE CLAIMS
Category Class Record Type: Performance:
Category Class Record Type: Performance:
Category Class Record Type: Performance:
Category Class Record Type: Performance:
High Point MSL Low Point MSL
POST FLIGHT

Post-Flight Waypoint Declaration For Free Flights
Record Type
Start Point Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Finish Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Would you like to add more Post-Flight Declarations?

YesNo
Record Type
Start Point Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Finish Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Record Type
Start Point Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Turnpoint Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Finish Location Name Latitude DD:MM.mmm LongitudeDDD:MM.mmm
Use your mouse or touchscreen to sign the electronic signature blocks below:
Pilot's Signature*

Clear
All of the above is true to the best of my knowledge.
Be sure to upload ALL files needed to process your claim. (Flight recorder – IGC file, Calibration, Any other documentation or narratives about your flight)
Upload Flight Recorder & Calibration Files*

Browse Files
Required for any flight documented by approved data recorder (igc, pdf, doc, docx, txt) Cancelof
OBSERVER INFORMATION
Observer's Name*

First NameLast Name
Observer's SSA Member #
Observer's Email*
Observer's Signature*

Clear
All of the above is true to the best of my knowledge.
If you click SAVE FOR LATER below, the screen will gray out. SCROLL UP and put in your email address. You will be sent a link to reopen and update the form. Use this if you need to finish the form later or to receive a link to send to your observer for a signature. The observer may then either SUBMIT the form for processing or SAVE the form and return it to you for completion.
Please verify that you are human*
Should be Empty:

PILOT INFORMATION

DISTANCE CLAIMS

SPEED CLAIMS

ALTITUDE CLAIMS

POST FLIGHT

OBSERVER INFORMATION