Fun Fly Event Entry Form for Oct 20 2022

FUN FLY EVENT!

at the Public Safety Drone Operations Day @ Xelevate 2022
Fun Fly Event! Come and participate on behalf of your department to be entered to win an American-made drone for your department!

First come first serve and limited slots!

*Must have a Remote Pilot in Command (RPIC) part 107 pilot and Visual Observer (VO) to participate.

**Limit 2 RPIC/VO entries per department, outdoor all-weather, bring your own drone, must complete paperwork to participate.

***Industry partners may come and participate, but are not eligible to win- departments only are allowed to win.
Department Name
Email of Primary Crewmember/Primary Remote Pilot In Command (PIC)
example@example.com
Office Number Primary Crewmember/Primary Remote Pilot In Command (PIC)
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Primary Crewmember/Primary Remote Pilot In Command (PIC)
Please enter a valid phone number.Format: (000) 000-0000.
Primary Crewmember/Primary Remote PIC Name

First NameLast Name
Primary Crewmember/Primary Remote PIC Certification #
Expiration Date of Remote PIC Certification #

MonthDayYear
Date
Primary Crewmember/Primary Remote PIC Hours Flown in Last 90 days
Crewmember #2 (Visual Observer) Name

First NameLast Name
Crewmember #2 (Visual Observer) Email
example@example.com
Crewmember #2 (Visual Observer) FAA Remote PIC Certification #
Expiration Date of Crewmember #2 Remote PIC Certification #

MonthDayYear
Date
Crewmember #2 Hours Flown in Last 90 days
Is there another Crewmember?
Crewmember #3 Name

First NameLast Name
Crewmember #3 Email:
example@example.com
Crewmember #3 Role (Check all that apply)
Crewmember #3 FAA Remote PIC Certification #
Expiration Date of Crewmember #3 Remote PIC Certification #

MonthDayYear
Date
Crewmember #3 Hours Flown in Last 90 days
Is there another Crewmember?
Crewmember #4 Name

First NameLast Name
Crewmember #4 Email
example@example.com
Crewmember #4 Role (Check all that apply)
Crewmember #4 FAA Remote PIC Certification #
Expiration Date of Crewmember #4 Remote PIC Certification #

MonthDayYear
Date
Crewmember #4 Hours Flown in Last 90 days
Should be Empty:

FUN FLY EVENT!