2019 Highland Village Lions Balloon Festival Pilot Application, Release, and Agreement
Last Name *
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First Name *
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Street Address *
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City and State *
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Zip Code *
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Cell Phone Number *
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Email *
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Request invoice payment by Credit Card- Invoice with payment link will be sent to above email. *
Airman Certificate Number *
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Pilot Certification *
If you been convicted of any offenses involving alcohol or drugs as outlined in 14CRF 61.15 or 61.16 while holding a pilot certificate in the last five years, have you filed the Notification Letter required by 61.15? *
Have you ever been cited by the FAA for violation of any FAR? *
If yes, please explain:
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Date of Last Flight Review *
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Total Hours of PIC in Balloon *
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BFA Competion Number *
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Balloon Name *
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Balloon Manufacturer *
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Balloon Model and Year *
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Registration Number *
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Date of Last Inspection *
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Total Number of Hours on Balloon *
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How much weight can your basket carry excluding pilot? *
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Insurance Company *
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Policy Number *
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Arrival Day *
Type of Hotel Room. *
Will you need additional rooms? *
Will you need crew *
If you need crew, which flights and how many crew will you need? *
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T-shirt size *
Would you like to order additional t-shirts? If so, how many and what size(s)?
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2019 Highland Village Lions Balloon Festival Pilot Entry Agreement Including Acknowledgement of Responsibility and Release of Liability
I hereby declare that I am participating in the Highland Village Lions Balloon Festival on August 16-18, 2019 of my own free volition. I agree that the Organizers and sponsors of this event including the Highland Village Lions Club, Highland Village Lions Foundation, the City of Highland Village, event race officials, your sponsor or any employees, officers, trustees, agents and/or members of the above mentioned entities) are providing me with the facilities and means for my participation in this event and in no way do they supersede the responsibility of the pilot in command, as shown in CFR § 91.3(a) and elsewhere in the Federal Aviation Regulations (FARs). *
Required
I do agree to have at least an LTA private pilot's certificate and will participate in all scheduled flights and/or tethers. *
Required
I hereby certify that I am aware of and agree with the responsibility legally transferred to me under the Federal Aviation Regulations (FARs) as regards my personal decision to fly my balloon, and any bodily injury or property damage resulting therefrom is solely my liability, and that my decision as pilot in command may affect my placement in this event if I choose not to fly. I understand that the pilot of each balloon has full and complete authority over the balloon and is responsible for all decisions to be made associated with the balloon on the ground and in the air. *
Required
I certify that I am of sound mind and body and I have no medical, mental, or physical limitations or conditions that would limit or impair my ability to safely fly my aircraft. I am not taking prescription or over the counter drugs/medications that may impair my ability to safely fly my aircraft. *
Required
Officials of the Highland Village Lions Balloon Festival may supply information, guidance, or data and will use reasonable care to ensure the information is accurate and complete. However, the Highland Village Lions Balloon Festival assumes no responsibility for the completeness or accuracy of such information. It is my decision whether to rely on that information or acquire additional information. I agree that none of the flights are mandatory and that I will make all flights at my option. *
Required
I hereby agree to have in force during the Highland Village Lions Balloon Festival a balloon insurance policy with a minimal liability limits of $1,000,000.00 each occurrence combined bodily injury and property damage, including passengers, but not less than $100,000.00 each passenger. *
Required
I hereby give permission, without any restriction, to Highland Village Lions Balloon Festival or its assigns, to use still and motion pictures and sound recordings of me, my balloon, equipment, chase crewmembers, employees and agents for news, advertising, promotional media and commercial uses. *
Required
I agree that this Agreement is a Texas contract and it is to be governed by the laws of the State of Texas, and that I hereby submit myself to the jurisdiction of the Texas courts concerning any claims arising out of the 2019 Highland Village Lions Balloon Festival or this Agreement. This Agreement, including the Conditions of Entry, General Information, Insurance and Hotel Reservation form, contains all the terms and conditions agreed to by the parties hereto, and no other agreements or discussions, oral or written, regarding the subject matter of the Agreement shall be deemed to exist or bind any of the parties hereto. *
Required
I, the pilot in command, hereby declare that I will fly in accordance with the event rules and regulations, abide by the FARs, and fly entirely at my own risk and waive any right of action against Highland Village Balloon Festival, the owner of the launch site, event race officials, your sponsor or any employees, officers, trustees, agents, and their respective members for any loss or damage sustained by me in consequence of any action or omission on their part, my part or the part of other participants. *
Required
Thus, I release the Organizers and sponsors of this event Highland Village Lions Club, Highland Village Lions Foundation, The City of Highland Village, event race officials, my sponsor or any employees, officers, directors, trustees, employees, volunteers, agents and sponsors and/or members of the aforementioned entities) from liability for my actions or inactions relating to the Highland Village Lions Balloon Festival which may arise out of or result from or in any manner be connected with the balloon flight or activity in which I participate as a pilot in command. *
Required
I certify that all information contained on the pilot application is accurate and I accept the terms of the entry agreement. *
Required
Electronic Signature- Provide First and Last Name *
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I understand that by checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Agreement. *
Required
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