Membership Form – Simpilot

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About Us
Simulators
Membership
Careers
Summer Programs 2025
Contact Us

Membership Application

Personal Information

Full Legal name: Last, First, Middle

Date

Permanent Address

City

State

Zip/Postal

County

Home Phone

Work Phone

Cell/Other

Driver License

Sex

Male Female Other

Marital Status

Married Single Divorce Widowed

Age

Date of Birth

Country of Birth

Country of Citizenship

Have you ever been convicted of a crime, whether felony or misdemeanor in the U.S. or in any other country?

Yes No

(if yes please explain and provide SimPilot with a certified copy of the final disposition in this matter):

Required Documentation and Information

Do you have previous flying experience?

Yes No

FAA Licenses

Total Hours

Have you ever taken any written knowledge test or practical test?

Yes No

If yes, please specified

If you decide to become a pilot, which program do you wish to enroll in?

Private Pilot Commercial Pilot Airline Transport Pilot Instrument Rating Commercial Pilot Add-on (Multi Engine)

Do You Have a High School Diploma?

Yes No

(Foreign National Members Only) Do you have a current US Visa?

Yes No

If yes, please specified:

Do you suffer from current or past Medical Conditions or Physical Ailments that may affect your ability to fly?

Yes No

If yes, please explain:

Do you have an FAA approved Medical Certificate?

Yes No

If yes, Type?:

1st 2nd 3rd

Have you obtained a U.S. TSA Approval?

Yes No

Clearance#:

In Witness hereof, I,

The Membership is $59.95 per year. Further understand that any monies paid in advance to Simpilot for Memebership Application Program is none-refundable. I also understand that my acceptance for enrollment in the Simpilot Membership Program is solely and exclusively based on the decision of Simpilot's administration

Signature (Student)

Date

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Office: (305) 934-0117