ROBINSON HELICOPTER PILOT SAFETY COURSE APPLICATION Please complete the following application and return it with legible copies of your Helicopter Pilot License (If helicopter rating … .. is pending, please see note in helicopter rating section), current Medical Certificate, and payment information. RHC accepts VISA, MasterCard, American Express, U.S. check or money order payable to Robinson Helicopter Company. Applications will not processed unless accompanied by the enrollment fee. Please Print Neatly. CONTACT NAME _____

HELICOPTER RATING CHECK ONE: PRIVATE q COMMERCIAL q CFI q ATP q CERTIFICATE # ________________________________________________ Helicopter Rating Pending ______________ (Initial) Note: If you are working towards your Helicopter Rating, you may sign up for the course; however, to attend the class you MUST have your rating prior to your scheduled course date. TOTAL HELICOPTER HOURS LOGGED __________ R22 HOURS LOGGED ___________ R44 HOURS LOGGED ____________ You must have at least 3 hours in a Robinson helicopter to attend RHC Pilot Safety Course. If you are a CFI, in which helicopter do you instruct? R22 q R44 q Which model would you prefer to fly during the course? R22 ($400) q R44 ($500) q Each pilot is only permitted to fly once during the safety course and in only one model. NAME OF ROBINSON DEALER OR FLIGHT SCHOOL: ____________________________________________________________ REGISTRATION PREFERRED SAFETY COURSE DATE: __________________________________________________________________________ If the regular flight schedule for your preferred course date is full, are you able to do the flight portion on Friday, one day following the class?* YES q NO q *Courses are typically booked several months in advance. If you are not able to fly the following Friday and your preferred course date is full, you will be scheduled on an alternate date. If no alternate date is selected, you will be scheduled on the next available course. ALTERNATE DATE SAFETY COURSE DATE _____________________________________________________________________ ADD ME TO THE WAITING LIST FOR EARLIER CLASS OPENINGS: YES q NO q PAYMENT Payment must be included with submission of the application or application will not be processed CHARGE MY: VISA q MasterCard q American Express q Check or money order enclosed q Payable to Robinson Helicopter Company

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