/ LUXEMBOURG BALLOON TROPHY 2018
Pilot Registration form

Registration Deadline: July1st, 2018

Registration byE-mail only at:

Pilot Information

Pilot Last/First Name

/ / Nationality: /

Polo size :

Date of Birth: / / Passport Nr
(non-EU. Pilots): / / Male / Female
Address: / Post Code: /
Place: /
Country: /
Mobile Phone Pilot / / Mobile Phone Crew / /
E-mail: / / AX hours P1: /
Ballooning CV:
(resume)
Pilot License Nr
& Validity Date: / / Delivering authority: / / FAI Sporting License Nr
& Validity Date: /
Balloon Information
Balloon Name: / / Balloon Registration: /
Balloon Size: / / Manufacturer: / / Type: /
Sponsor: / / Main Colors: /
DOCUMENT / NUMBER / DELIVERING AUTHORITY / VALID Til
Registration Certificate : / / /
Airworthiness Certificate : / / /
Annual Inspection Certificate : / / /
Insurance Company: / / Policy Nr.
and Validity: / / Third Party Limit: /
Team Information
Team Name: /
Team Members
(excluding the pilot): / 01 - /
02 - / / Languages: / English / French
03 - / / German: /

Other:

Contacts in case of Emergency: /
Entry Fee

Entry Fee: €650.-. To be paid via Bank transfer to the Cercle Luxembourgeois de l’Aérostation account at

BANQUE GENERALE DU LUXEMBOURG Bic BGLLLULL, IBAN account nr.:LU93 0030 5466 1857 0000before July 1st, 2018.

The organizers will confirm reception within 10 days after having received your payment.

You will receive a confirmation of your registration. If you don’t get any confirmation, please contact the Organizers via

Your registration will only be considered if you have received a confirmation from the organizers and when the payment of your entry fee has been received.

Important : Please send a picture of the pilot and the balloon for the official website and program.

Date: / Signature:

Pilot Registration Form

Registration Deadline: June 30, 2018

Important Notes

By entering the event, I declare that I will have the following documents available for any required or requested check by the organizers or authorities:

- Valid Pilot License - Medical Certificate - Pilot’s logbook

- Balloon logbook- Balloon Certificate of Registration - Balloon Certificate of Airworthiness - FAI Sporting License

- Insurance Policy

Pilot Agreement
As a Pilot participating inthe Luxembourg Balloon Trophy :
I declare that all information provided to the Organizers on my Registration Form are correct and true;
I agree to follow the rules and regulations applicable to the event;
I authorize the Organizers to publish information from my Application Form on the official website and program;
I understand and agree that I enter and participate in the event at my own risk and I that I agree to release the LBT, its organizers, sponsors, officials and volunteers from liability for their actions or inactions relating to the event.
I understand and agree that the participating balloonsare at any time under the complete authority of the pilotswho are and remain responsible for all decisions to be made in association with the balloon operation on the ground and in the air.
Officials of the LBT may supply information, guidance or data, but I understand that I act or rely on all such information at my own peril and the organizers of the LBT assume no responsibility for the completeness or accuracy of such information.
I understand that none of the flights are mandatory and that I will make all flights at my option. My decision as Pilot in Command may affect my standings in competitive events and any compensation to which I might otherwise be entitled.
I declare that I am participating in the LBT at my own choice.
The Organizers of the event may at any time and at their sole discretion cancel any or all of the LBT and may cancel my participation at any time and at their sole discretion, in which case the Entry Fee will be returned.
I give full permission to LBT and its authorized representatives, to use any picture, movie, data or sound recording of me, my balloon, equipment and team members for news, advertising, promotional media and commercial use.
With my signature below, I certify that all information I provide in the Pilot Registration Form is true and accurate, and that I accept the terms of the Pilot Agreement above.
Date: / Name: / Signature:
/ Luxembourg Balloon Trophy 2018
/ Entry Form - pg. 1/2