VPA - Pilot Application

Personal Information

Name:

Company/Title:

Address:

City:	State:	Zip:

Home:	Work:	Fax:

Mobile:	Pager:	Other:

Email:

Pilot Information

Certificate Number(s):

Medical Class:	Exam Date:	Date of last BFR:

Certificates & Ratings Held:
SEL MEL INS COM CFI ATP Other

Flight Hours

Total:	Single Engine:	Multi-Engine:	Instrument:	Night:

Airport Information

Please list only the airport from which you fly most frequenty

I Fly From:	State:	Airport Identifier:

For VPA flights, consider me a:
Pilot Copilot
For VPA listing we consider a "Pilot" to be an aircraft owner, renter, or someone who has access to an aircraft and is willing to pay the expenses associated with the flight. A "Copilot" would fly right seat and not typically be expected to pay any of the expenses.

Aircraft Information

Complete this section only if you have a specific aircraft available for VPA flights

Make:	Model:	N-Number:

Engine: Single Twin

Cruise Speed:	Seats:	A/C Colors:

Special Equipment:

Mission Information

Please read the following carefully and fill in the applicable information. If you have any questions, please contact us.

VPA member pilots fly two basic types of missions. The first is to recover donor organs and the second is to transport needy patients and their traveling companions.

Most organ recovery flights are flown late at night (after 11:00pm), when there are no commercial flights available. Please check, if you are willing to receive phone calls and fly late at night.
Please check if you are willing to fly on missions trasporting patients and their travelling companions.

Miscellaneous Information

If you have any further information or comments, please let us know:

I have read and understand the operational guidelines set forth by the Volunteer Pilots Association (VPA). I will not hold the VPA, its officers, directors, agents, or associates responsible for any losses as a result of any activity associated with the VPA. I also agree to abide by any operational guidelines set forth by the VPA while conducting a flight on its behalf and to follow any a applicable rules set forth by the Federal Aviation Administration. I give the VPA permission, at the VPA's option, to list information contained on this application and pass it on to other VPA members.