BeckerHelicopters
Enrolment Form
 

Thankyou for choosing us!
Please fill out the form below as accurately as possible.
If you make any obvious mistakes you will be notified before the form is sent.
We need any fields marked with *

Please read our Code of Conduct which provides important information.
 
*Name:
*Address:
Address 2:
*Suburb / City:
*Post Code / Zip:
*Country:
 
*Home Phone:

Include country code

Mobile:
*Email:
 
*Date of Birth:
*Country of Birth:
*Nationality:
Drivers Licence:
*Next of Kin:
*Next of Kin
Contact details:
*Your Weight Kg OR pounds
Note:  Please be honest.  This helps determine the type of helicopters you can train in, and in turn your course costs.
 
PPL/CPL Licence Courses: The PPL/CPL Licence courses includes the ground school helicopter theory.
  
Other Endorsements & Courses:
Theory Only Courses:
Preferred Start Date :
*Code of Conduct

Have you read and do you agree to the terms and conditions stated in the Code of Conduct?

Yes
No

*Medical Completed?

Yes
No

*Accommodation required?

Becker Pilot Accommodation
No thanks, I will arrange my own accommodation

Comments:
International Applicants - Passport details (Required for Visa)
Passport Number:
Place of issue:
Date of issue: