NEW SSA Badge & Award Application

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
BADGES
Altitude Claim(s)
Duration Claim
Distance Claim(s)
Diplome Claim
AWARDS
Flight Date*

MonthDayYear
Is the aircraft a motor glider?*

YesNo
Flight Crew
Crew Only allowed on Awards
Flight Crew Gender

MaleFemale
SSA Member #
Aircraft Make & Model*
N#*
WAYPOINTS
Include your Internet Declaration (if no flight recorder declarations) with your documentation uploads ONLY for GOLD distance. All other distance tasks require declarations electronically entered into the flight recorder.
If START & FINISH points are selected post-flight:
Start Point Location Name Latitude DD:MM.mmm Longitude DDD:MM.mmm
Finish Point Location Name Latitude DD:MM.mmm Longitude DDD:MM.mmm
TAKE-OFF SITE
Site:*
Local Time*

:HourMinutes
Nearest City:*
State:*
Elevation (MSL):*
Club Name*
Time of release (or last motor glider Means of Propulsion use):Local Time*
Confirmed by:

OO’s Personal ObservationSoaring Site logWitnessFlight Recorder Data
List the location as accurately as possible; if overhead at an airport, list published airport coordinates. I hereby certify the following as the release location for the flight listed above. Latitude: DD:MM.mmm Longitude: DDD:MM.mmm .
Use your mouse or touchscreen to sign the electronic signature blocks below:
Tow Pilot / Launch Supervisor Signature

Clear
I hereby certify I witnessed the above pilot & aircraft at the date, time and location shown above.
Tow Pilot / Launch Supervisor Name

First NameLast Name
ALTITUDE EVALUATION

Refer to the SSA Badge & Record Guide to find altitudes MSL, corrected for both instrument error and non-standard pressure
ALL CLAIMS (Release)
ALTITUDE CLAIMS (Low Point)
ALTITUDE CLAIMS (High Point)
DISTANCE CLAIMS (Start Altitude)
DISTANCE CLAIMS (Finish Altitude)
LANDING SITE
Site:*
Local Time*

:HourMinutes
Nearest City:*
State:*
Elevation (MSL):*
Confirmed by:

OO’s Personal ObservationSoaring Site logWitnessFlight Recorder Data
Did you make an off-field landing?*

YesNo
Off-Field Landing Witness Signature*

Clear
I hereby certify I witnessed the above pilot & aircraft at the date, time and location shown above.
Off-Field Landing Witness Name*

First NameLast Name
Off-Field Landing Witness Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PILOT CERTIFICATION: I hereby certify this flight was conducted in accordance with the FAI Sporting Code, in compliance with all the glider manufacturer's and national operating limitations, and in accordance with national flight regulations respecting airspace use, night flight, etc. I apply for the award(s) checked above. If you made a written declaration for Gold distance, upload your time-stamped file from pre-flight.
Pilot'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.

OBSERVER INFORMATION
OBSERVER CERTIFICATION*

GPS data supports this application; I provided supervision of this flight as required by Sporting Code Section 3.This application is for Silver Duration only and I provided the continual attention required to confirm 5 hours were flown.
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 File (IGC File), Calibration File, Flight Narrative or Notes

Browse Files
Required for any flight documented by approved data recorder (igc, pdf, doc, docx, txt) Cancelof
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.
Please verify that you are human*
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.
Should be Empty:

PILOT INFORMATION

BADGES

WAYPOINTS

TAKE-OFF SITE

ALTITUDE EVALUATION

LANDING SITE

OBSERVER INFORMATION