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  EB Helicopters :: Flight Training :: Potential Student Information Form  
 
Personal
Name
Street Address
Town/City
State/Province
Postal Code
Country
Phone
Email Address
Date of Birth
Age
Citizenship
Requested Course
please specify your requirements.
   Commercial
 Private
 Alternate Commercial
 Alternate Private
 Aircraft Type Rating
 Robinson R22
 Robinson R44
 Bell 206B
Other (specify)
Starting date
   I would like to secure a spot on the course. Please find enclosed a cheque for the amount of:
 I do not wish to secure a spot on the course at this time, you will not find a cheque enclosed.