New Member/Student Contact Information

New Student/Member Contact Details

Please fill this form out so that we can set up your account on our booking software.
1. Personal Details
Name*

TitleGiven namesFamily name
Address*

Street Address

Street Address Line 2

SuburbState / Province

Postcode
Date Of Birth*

DayMonthYear
Date
Phone Number*
Format: 0000-000-000.
Email*
example@example.com

3. Aviation Credentials & Training Experience
This section is for those with existing pilot/medical credentials. You may skip this section if it is not applicable.
Aviation Reference Number (ARN)
Medical Class
Medical Expiry Date

DayMonthYear
Date
Pilot Licence Type
Licence (Flight Review) Expiry

DayMonthYear
Date
Licence/Medical Upload

If you have a scanned copy of your licence or medical, please upload it here so we can attach it to your profile. If not, we will scan this before your first flight.
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Applicant’s Declaration and Signature
Signature*

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Date*

DayMonthYear
Date
Once this application is received, you will receive an email from smartaviation.net to set up your student profile.
Who should we send your responses to?*
If someone has asked you to fill out this form, please select it here. If unsure, leave as reception.
Should be Empty:

New Student/Member Contact Details