NIFA

REGIONAL SAFECON

HOST INFORMATION FORM

INSTRUCTIONS:Please provide the information requested below. If there are sections for which you do not

know the answer at this time, leave them blank. What is most important is submitting whatever information you have now, so that the support process can begin. Providing the requested information willhelp to ensure the success of your SAFECON. You will have several opportunities to finish completing the form before your competition.

To make the process as easy as possible and taking advantage of email, this form was prepared as a table in Microsoft Word. Simply tab to the empty field for which you have information, and insert your response. When you are finished, save the form to your hard drive. Then attach it to an email response to the NIFA National Headquarters at. Your assistance is greatly appreciated!

General Information

Name of host institution:
Dates of your SAFECON:
Name of the airport being used:
Airport identifier:

Advisor Information

Name of SAFECON advisor:
Office mailing address:
Work phone:
Work FAX:
Work E-Mail;
Home phone:

Student President Information

Name of SAFECON president:
Office mailing address:
SAFECON phone:
SAFECON FAX:
SAFECON E-Mail:
Home phone:

Chief Judge Information

If the chief judge you have selected is not on the approved list provided by NIFA,

You must submit a ‘Regional Chief Judge Approval Request Form”

Name of SAFECON chief judge:
Mailing address:
Phone:
FAX:
E-Mail:
*Cell phone:

* This number will not be given out and will only be used as a last resort.

Events Scheduled

Place an X in the space next to each event you will be contesting.

Power Off Landings / Ground Trainer
Short Field Landings / Manual Flight Computer
Navigation / Aircraft Recognition
Message Drop / Preflight Inspection
SCAN / Other:

Event Material Requested

Place an X in the space next to the event materials you will need. Regions holding their SAFECONS after December 31st of the competition year (July 1st – June 30th) will not be provided with any test materials, only award medallions. NIFA will provided, free of charge to each region, 5 medallions with ribbons and 15 laser compatible blank award certificates for each official NIFA event contested (events listed in the NIFA Rulebook). In the case of the Navigation event and the Message Drop event, 10 medallions with ribbons and 30 certificates will be provided free of charge. Additional certificates and medallions may be purchased at cost +shipping. Contact NIFA Headquarters for details. All materials will be shipped to the SAFECON advisor unless otherwise instructed. Test materials will be in separate boxes marked “DO NOT OPEN - HOLD FOR CHIEF JUDGE”
Aircraft Recognition Test / SCAN Test
Manual Flight Computer Test / Ground Trainer Pattern
Award Medallions / _____ Extra Medallions