US National / International Soaring Record Application

PILOT INFORMATION
* Required Fields
Pilot's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
SSA Member #*
Nationality
FAI ID #
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 Nationality
Crew's FAI ID #
Crew's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Crew Email
Departure Date*

MonthDayYear
GMT Date
Departure Airport*
State in which the Start Point is located*
Release/MOP Alt*
Release Time*
Aircraft Make & Model*
N#*
Was this a Motorglider?

YesNo
Landing Site*
Landing State*
Landing Date*

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

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

Not all distances are available for each record type - See current rules
Category: Class: Record Type: Speed:MPH Actual
Category: Class: Record Type: Speed:MPH Actual
Category: Class: Record Type: Speed:MPH Actual
Category: Class: Record Type: Speed:MPH Actual
Category: Class: Record Type: Speed:MPH Actual
Category: Class: Record Type: Speed:MPH Actual
Start Time (GMT)
Finish Time (GMT)
Elapsed Time
ALTITUDE CLAIMS

Require Flight recorder calibrations within 5 years of flight and within 2 months after flight
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.
Upload ALL files needed to process your claim. (Flight recorder – IGC file, Calibration, Any other documentation or narratives about your flight)
Upload Files*

Browse Files
Required for any flight documented by approved data recorder (igc, pdf, doc, docx, txt) Cancelof
PAYMENT
Number of Records*
PAYMENT: After the Dossier is created and reviewed, you will be sent a payment link to complete your record claims at the current prices per record.
- NAA Review of US Record claim - $100
- NAA Review of US and International Record claim - $150
- Additional charge for review of claim when time exceeds 1.5 hours. - $50 per ½ hour
Other fees are assessed for international records by FAI
- FAI Surcharge (depends on current exchange rate) - $375
- FAI Proficiency/Achievement Badge - $150
Please indicate if you want additional options:
Extra Certificates - $49
enter quantity
Unmounted NAA Certificate (11”X14” portrait or landscape) - $49
enter quantity
Mounted Plaque ( 12 ½” X 15 ½”) FOR CERTIFICATE OR DIPLOMA (Assembly required) - $99
enter quantity
OBSERVER INFORMATION
Observer's Name*

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

Clear
Homologation of US National Record (includes 11 x 14’ certificate) for each record claimed. $100/each
Do you want the certificate(s) to be mounted?

Yes (adds $79 to each Record)No
Mounted Sub Total
This do-it-yourself assembly kit includes: 1 hardwood plaque (12-1/2”x15-1/2”), 1 plexiglass protective cover (11”x14”), and silver mounting tacks.
Do you want extra certificate(s)

Yes (adds $49 to each Record)No
Extras Sub Total
Do you want the extra certificate(s) also mounted?

Yes (adds $79 to each Record)No
Extras Mounted Sub Total
TOTAL AMOUNT OWED
Please hold the Certificate for Presentation.

YesNo
How would you like to Pay?

Pay by Check or Money OrderPay Online via Paypal
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

PAYMENT

OBSERVER INFORMATION