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.
Cell Phone Primary Crewmember/Primary Remote Pilot In Command (PIC)*
Please enter a valid phone number.
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?*

YesNo
Crewmember #3 Name*

First NameLast Name
Crewmember #3 Email: *
example@example.com
Crewmember #3 Role (Check all that apply)*

Remote Pilot in Command (PIC)Control ManipulatorVisual ObserverGuest
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?*

YesNo
Crewmember #4 Name*

First NameLast Name
Crewmember #4 Email *
example@example.com
Crewmember #4 Role (Check all that apply)*

Remote Pilot in Command (PIC)Control ManipulatorVisual ObserverGuest
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!