Blue Grass Airport Lexington, KY 40510 859-254-8906 www.aerotech.net
Application for Rental Permit
Print, complete and bring with you to checkout with required attachments
All blanks must be filled in. Write “N/A” if not applicable
Full Legal Name __________________
Address as appears on FAA Certificate
Current Address _____________________________
Cell __________________Emergency Contact Phone
Social Security #
______ Pilot Certificate# _______________________
References for schools/clubs where you previously trained/rented_______________________________________________________
Employer Name _______________________
Employer Work Phone#
_____________ St___ Zip_____________
FAA Medical Certificate. Date_____/_____/_____ Class________
List Waivers: If none, write none________________________
FLIGHT EXPERIENCE Total Hours ____________ Hours last 90 days: __________ Hours Actual Instrument_______
Which Make and Model (M/M) aircraft are you requesting privileges?______________________________ Hours in this M/M________
Please explain fully any “Yes” answers to the following questions.
-Have you had or been involved in any aircraft accidents/incidents?
-Have you been found guilty of any Federal Air Regulation violations?
-Has your automobile operator’s permit ever been suspended or revoked?
-Have you been arrested for operating an automobile under the influence of alcohol or d