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Tandem Instructor Questionnaire

Please provide the following information. Enter a "0" or "n/a" for any items that do not apply.
If you would prefer you may download the PDF version and e-mail or fax it to us at:
email: FAX: 407 850 6978

Personal Information

First Name: Last Name:
Street Address:
City: State: Postal Code:
Country:
Phone Number:
E-mail Address:

Jump Information

My Current Home Drop Zone is:
I hold the following Instructional Ratings:
I currently have the following medical certificate:

I have made jumps as the Instructor on the Strong Tandem Systems, and jumps as the Instructor on other Tandem Systems.

I have made jumps as a Passenger on the Strong Tandem Systems, and jumps as the Passenger on other Tandem Systems.

In the past 12 months I have made jumps on the Strong Tandem Systems, and jumps on other Tandem Systems.

I have had reserve activations on the Strong Tandem Systems, and reserve activations on other Tandem Systems.

I have made solo jumps in the past 12 months, and total solo jumps with total solo malfunctions.

Additional Comments