Les Ailes Cognaçaises Rallye Aérien International de Cognac ENTRY FORM To the 37 ème Rallye Aérien International de Cognac – 13 and 14 june 2009 PILOT

Name :.......................................................................................................................................... Firts Name : ............................................................ …. Nationality : .......................................... Address : ..................................................................................................................................... ..................................................................................................................................................... Tel. N° : ...................................................... E.mail : ................................................................. Pilot license N° : ........................................ Expiry date : .................................................... AIRCRAFT

Type : .............................Registration N° : .............................Number of seats : ................... Maximum take off weight : (kg)................... True ground speed for the navigation test : ............................... (For calculating the time for the navigation the true ground speed will be needed). INSURANCE Company:...................................................Contract N° :.......................................Valid :........................................ PASSENGERS Names

Firts names

Nationality

ACCOMODATION IN COGNAC

*Single bed bedroom(s) for one person : ......... .. *Single bed bedroom(s) for two persons : ........ .. *Double bed bedroom(s) for two persons : ...... .. EXPECTED ARRIVAL DAY and TIME IN COGNAC : ................................................... ENTRY FEES/ OTHER PARTICIPATING EXPENSES

Entry Fees : …………………………………… ….50.00. € Participating expenses : € 250 x ……….…… pers. = ………0.00.€ Total : ........... 0.00.€ Payment: by cheque made out to the order of the « Aéro-Club de Cognac ».To be attached to the entry form to validate it. Or by transfer to our account IBAN : FR76 1864 5004 0104 9323 2106 830

Les Ailes Cognaçaises – BP 91 16103 Cognac Cedex France tél. : 33 (0)5 45 82 13 51 http://aeroclub.cognac.free.fr E-mail [email protected]

Les Ailes Cognaçaises Rallye Aérien International de Cognac SWORN DECLARATION I undersigned, .............................................................................................. , fully agree to participate in the Cognac International Air Rally, according to the conditions specified below, and with the aircraft mentioned in this entry form. I also declare that I fully know the Rally competition rules and that I promise: 1. To observe all the flying rules and instructions which may be given by the Cognac control and the rally commissaries. 2. To be the only person responsible for all incidents or accidents which could happen to my aircraft on the Cognac airport ground and in the hangars or parking areas as well as those of the Cognac military air-base for whatever reason either meteorological normal or exceptional or even due to a bad mooring, etc. 3. To be the only person responsible for all kinds of damages to other people, public, military , keeping order units, planes, vehicles, etc., generated by my aircraft. 4. To take off from Cognac airport only with the Aero-Club’s and Cognac TWR authorisation. 5. To renounce to all recourse against the rally organizers, the French Aeronautical Federation (FNA), the French Army for all damages which could happen to myself, my passengers or my aircraft for whatever reason. 6. To renounce to introduce any lawsuit against the rally organizers, the FNA or French Army, for reasons linked to the rally organisation. I also declare to be insured against all risks to third parties that could happen during the rally. Place :…………………. Date ................................. Obligatory signature of the pilot to put in front of mention "read and approved"

37 ème RALLYE AERIEN INTERNATIONAL DE COGNAC 13 et 14 JUIN 2009 LES AILES COGNACAISES BP 91 16103 COGNAC CEDEX Mail : [email protected] Infos sur site Web : http://aeroclub.cognac.free.fr/ Tel : 05 45 82 13 51

Les Ailes Cognaçaises – BP 91 16103 Cognac Cedex France tél. : 33 (0)5 45 82 13 51 http://aeroclub.cognac.free.fr E-mail [email protected]