Pilot Chemical Rating - INITIAL Registration Form

Pilot Chemical Rating - INITIAL Registration

Please fill out this form for PCR Initial Course (Drone or Pilot)
Please complete the Registration Form below so we have your details before your scheduled Training Date
Today's Date*

DayMonthYear
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Email Address*
Mobile Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company / Employer Name*
ID - please upload a copy of your Drivers Licence/Passport/Fire Arms*

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Pilots Licence - FRONT (If you are a Pilot this MUST be uploaded)

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Pilot Licence - BACK

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Training Date

Please let us know which PRC Course you are scheduled for. These dates were sent out via Email
PCR Training Date/s *
Please select which Course applies to you:*

PCR Initial Course - PilotPCR Initial Course - Drone
Pricing:

Initial Course: Pilot or Drone

$4475 + GST

Please specify who you would like the Invoice sent to with Name, Address, Phone Number and Purchase Order #
Company/Business Name to send Invoice to:*
Company/Business Email for Invoice*
example@example.com
Company Address for Invoice*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone Number*
Purchase Order Number for Invoice (if you have one)
How did you hear about this Course?*

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