* = Required Field
FLIGHT ATTENDANT ENROLLMENT FORM
Date of Training * (Mo / Day / Year)
Type of Training Requested *
TYPE OF TRAINING Flight Attendant
Name (Last, First, Middle) *
SSN (US Only)
Date of Birth (Mo / Day / Year) *
Place of birth (City, State, Country
Eyes *
Eye Color Brown Blue Green Hazel Black
Height
Weight
Hair
Permanent Address
City
State
Zip
Country
Sex *
Sex Male Female
Citizenship *
Do you read, write and understand English?
Home phone
FAX number
Cell Phone
E-mail address *
Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, depressant or stimulant drugs or substances?
Yes No Date of final conviction:
Tuition Deposit: By submitting this form I authorize Aeroservice Aviation Center to charge my credit card for the Tuition Deposit amount indicated below. I understand that this amount will be applied to my account in full and is not refundable. In the case of a cancelation I may apply these funds to any other course offered by Aeroservice Aviation Center within 12 months of the date of this enrollment form.
Select Amount *: AUTHORIZED CHARGE AMOUNT Flight Attendant Deposit: $1,500.00
Credit Card *: CARD TYPE Visa Master Card American Express Discover
Card Number *:
For your protection, we ask that you enter an extra 3-4 digit number called the CCID. The CCID is NOT your PIN number. It is an extra ID printed on your Visa, MasterCard, Discover, or American Express Card.
Security Code *:
Expiration Date *: MONTH January February March April May June July August September October November December YEAR 2008 2009 2010 2011 2012
Electronic Signature (Please type your name here) *:
By submitting this form I certify that all statements and answers provided by me on this application are complete and true to the best of my knowledge and I agre that they are to be considered as part of the basis for issuance of any FAA or Company certificate to me.
