Registration ULM Pilots Contact information NAME and surname * Address * Postal Code * City * Country * Mobil phone (+ country code) * Email * Date of birthday * Nationality * Gender * MaleFemale Pilot I'm a ULM Pilot * Pilot's license n° * FFPLUM license number FAI licence 2019 number Club * Insurance Name of your Insurance * N° contract insurance * End of contract date * Machine Aircraft types * Information concerning the aircraft coming into flight (Any change of your aircraft will cancel your registration) Ultralight trikeFixed-wing Ultralight aircraftGyrocopterUltralight Helicopter Aircraft Manufacturer * Model * Identification number * Radio is mandatory Arrival/departure I will be accompanied by * If it's known ----yesnoI don't know Name, surname and telephone number of this person Contact person present at the Coupe Icare in case of necessity * Notify name, surname and mibil phone This person will be present at the Coupe Icare ? * yesno Expected day and time of arrival * Please, check instructions and authorized flight times Expected day and time of departure * Please, check instructions and authorized flight times Signature Participant declaration * - I certify the information above ; - I certify that I have read all the information, all flight instructions related to the Lumbin ULM Base and all instructions related to the restricted areas ; - As a pilot-in-command, I take the full responsibility for my actions, I alone assume the risks of flying my aircraft for landing and taking-off from/to the Lumbin ULM base. I release the organization of any responsibility in the event of an accident and I undertake to make no appeal to the organization; -The parcked ULM are not under the responsibility of a the Field Manager during my absence (I think especially theft, wind and vandalism) Entrez le mot tel qu'il apparaît dans l'image ci-dessous *
