Pilot Chemical Rating REFRESHER

Pilot Chemical Rating REFRESHER - Registration

Please fill out this form for PCR Refresher Courses
Below are the steps required to Register for PCR Refresher Training

1.Register for Training by filling out this Form

2. Complete Training via Classroom or Online (Teams)

3. Complete Assessment
Today's Date*

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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 - (if you have one) - FRONT

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Pilot Licence - BACK

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Chemical Rating Log Book Sticker

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Current Chemical Rating certificate

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Only required to include this if you haven't supplied copy of Chemical Rating Log Book sticker. Cancelof
Training Date

Please let us know which online PRC Refresher Course you are scheduled for. These dates were sent out via Email
PCR Refresher Date:*

DayMonthYear
Date
Invoice Details

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)
Online Training Details:

Please provide an Email Address for the Training Link to be sent to and a Postal Address for Course Material to be Couriered to.

Please note Training Material won't be sent until Payment has been recieved or Purchase Order has been confirmed.
Email for Training Link
example@example.com
Address Details for Course Material to be Couriered: (can be a Business or Personal Address)
How did you hear about this Course?*

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Pilot Chemical Rating REFRESHER - Registration