FINGER LAKES AREA PILOTS, INC.
P.O. BOX 606
SENECA FALLS, NY 13148
First Name:_____________________ MI:____ Last Name:_____________________
Street Address:____________________________ City:_________________________
State:___________ Zip:__________________ SS#_______/_______/___________
Home Phone:(___)_______-__________ Work Phone:(___)______-________________
E-Mail:_________________________________ Date of Birth:______/______/______
Pilot Certificate Held (circle): None Student Recreational Private Commercial ATP
Ratings (circle all that apply): INST SEL MEL CFI CFII OTHER_______________
Total Flight Hours: _______________ Hours in last 12 Months:__________________
PA-28 Hours: _______________ PA-28 Hours in last 12 Months:________________
Date of FAA Medical: ____/____/____ Date of Biannual:____/____/____
Any FAR Violations: Yes No (circle)
If you answer yes to either of the following two questions, please provide details on a separate sheet.
Has your driver's license ever been revoked or suspended?: Yes No (circle)
Have you ever been convicted of a drug or alcohol related offense? Yes No (circle)
Please mail completed application to
Finger Lakes Area Pilots, Inc.
P.O. Box 606
Seneca Falls, NY 13148