8th U.S. NATIONAL
MICROLIGHT CHAMPIONSHIPS
Scottsburg Airport (3R8) – Scottsburg, IN – September 22-25, 2004
Hosted by: Kentuckiana Ultralights Inc. & Scottsburg Aero Club USUA
167
SANCTIONED BY THE UNITED STATES ULTRALIGHT
ASSOCIATION,
an
affiliate member of NAA and FAI
Registration must be maid by mailing this
entry form and entry fees. If possible,
you should first pre-register at http://www.flymicro.com/comps
to get your COMPS-assigned pilot number.
Name _________________________________________________________________________
Address _________________________________________________________________________
City __________________________________ State ________ ZIP ________
Phone __________________________________ E-mail __________________________________
Age on September 22, 2004: ______
Sex: ______
Pilots and Navigators: (Entry may be submitted without these
numbers, but must be provided before competing.)
FAI Sporting
License Number: _____________
USUA Member
Number: _____________
COMPS-assigned
Competitor Number: _________
Competition
Class: (Check one)
|
¨ AL1 – Fixed
Wing Solo ¨ AL2 – Fixed
Wing Dual |
¨ PF1 – Powered
Paraglider (Foot
launched) |
¨ PL1 – Powered Parachute Solo ¨ PL2 – Powered Parachute Dual |
¨ WL1 – Trike Solo ¨ WL2 – Trike Dual |
Entry
Type:
|
Check
one: |
Entry Fee |
|
¨ Pilot |
$200 |
|
¨ Navigator |
|
|
¨ Assistant |
$30 |
Note:
Each registered participant (Pilot, Navigator, and Assistant) must submit an
individual Entry Form, preferably submitted together.
Navigator
and Assistant registrations must be associated with a Pilot registration. A photograph and a short biographical note
for each registered participant should be provided at www.flymicro.com/comps, or attached to
this Entry Form.
Navigator
and Assistants: print Pilot’s name: __________________________________
AL2, WL2, and PL2 Pilot entries: print Navigator’s name: __________________________________
Pilot
entries: Assistant name(s): __________________________________
Total
fees enclosed, reflecting any discount/surcharge: $____________
(Make payment to: “Kentuckiana Ultralights for Microlight Championship”)
There is a 20% discount for registration and payment
postmarked prior to July 1, 2004.
There is a 10% discount for registration and payment postmarked prior to August
1, 2004.
There is a 25% surcharge for registration and
payment postmarked after September 1, 2004.
Any application and/or payment received after September 1, 2004 may be refused at the sole discretion of the organizers, in which case payment will be declined. No refunds will be made. Entry may not be transferred to another pilot. Anyone who is not a registered participant is a spectator. Spectators are not allowed in controlled areas of the airport. Spectators do not need to register in advance.
All
entrants must provide proof of ultralight third-party liability insurance
during the on-site check-in in the minimum amount of $1,000,000 per occurrence
and $100,000 per person provided through First Flight Insurance Group, Inc. or
another insurance carrier acceptable to USUA in USUA’s reasonable
discretion. You do not need to mail
proof of insurance.
I have read and promise to abide
by the Championship’s Local Regulations, Official U.S. Microlight Contest &
Records Rulebook and the FAI Sporting Code Section 10. I declare that the above information is
true.
Signed : ___________________________________________________ Date ___________________
Mail this Entry Form, the Hold Harmless
Agreement, and payment to:
Kentuckiana
Ultralights. Inc.
U.S. National
Microlight Championship Registration
Scottsburg
Airport
2527 S. Lake Rd.
Scottsburg, IN
47170
Hold Harmless Agreement
This form must be completed and accompany the
application.
Conditions For
Acceptance as a Participant In The 8th National Microlight
Championships:
In return for acceptance as a participant in
the 8th National Microlight Championships, the applicant agrees to
the following terms:
(INITIAL
EACH CONDITION)
____ 1. I freely and voluntarily assume the risks
of ultralight flight and I, or my heirs, promise to hold USUA and the host, organizers,
staff and officers of the 8th National Microlight Championships
harmless for injury or damage caused by my ultralight flying activity.
____ 2. Never to bring suit or any legal action
against the USUA or the host, organizers, staff and officers of the 8th
National Microlight Championships with regard to any consequence which may
occur as a result of this action.
____ 3. To abide by all federal, state, and local
regulations pertaining to ultralight flying.
____ 4. To operate an ultralight only when no
physical conditions exist that may interfere with safe piloting practices.
____ 5. . I certify that all statements made on
this form are true and correct.
I, understand that
ultralight flying is a potentially dangerous activity that can result in injury
or death. EACH INDIVIDUAL PARTICIPANT, REGARDLESS OF EXPERIENCE, HAS FINAL
RESPONSIBILITY FOR HIS OR HER OWN SAFETY. THE UNITED STATES ULTRALIGHT
ASSOCIATION is a voluntary membership organization of the participants and
supporters of ultralight aviation. USUA, AS A PRIVATE NON-REGULATORY
ORGANIZATION WHICH HAS NO LEGAL AUTHORITY TO REGULATE OR CONTROL INDIVIDUALS OR
CORPORATIONS, AND THE HOST, ORGANIZERS, STAFF AND OFFICERS OF THE 8TH NATIONAL
MICROLIGHT CHAMPIONSHIPS, CANNOT BE HELD LIABLE FOR ANY FLIGHT OPERATIONS THAT
RESULT IN INJURY OR DEATH TO ANY PARTY. All references to self-regulation refer
to each individual person regulating or being responsible for him or herself.
It is the responsibility of each participant to ask whatever questions are
necessary for him or her to have a thorough understanding of the actions and
procedures that he or she must perform in order to make a safe flight. Each
ultralight pilot has the responsibility to exercise certain practices and
perform certain actions to maintain safety for himself or herself and for other
people.
_______________________________ __________
Participant Signature Date
_______________________________
Participant name (printed)