Name: 

Contest Number: 

Aircraft N number: N

Sailplane Make & Model: 

All up (dry/no ballast) flying weight, used to figure the handicap: 

Insurance Carrier/ID:  

Address Street:          

City/State/Zip:   

Phone Home: 

Phone Cell:

Email: 

Emergency Contact Name:  	

Emergency Contact Phone:  

Is your glider FLARM equipped?  yes/no
Is your glider ELT equipped?  yes/no    older 121.5 or 406Mhz?  
Do you have an Personal Locator Beacon? 
Do you fly with a SPOT, InReach, or Cell phone, gps tracking device?  
    if yes please include your personal tracking info / web link/ etc.
    AND please Register with the SSA Sailplane Tracker
http://www.ssa.org/SailplaneLocator

Race Division A Class (Experienced) or B Class (Novice):  

Highest FAI Badge: 

Approximate number of off-airfield landings:

Most recent SSA-sanctioned contest flown: 


        Suggested donation for Trophy, website and other expenses $22 

        There are 3 Payment Options:
1. Pay the annual donation via PayPal button on the website (paste into browser):
https://www.paypal.com/webapps/shoppingcart?flowlogging_id=9999d7e9ea588&mfid=1511719890710_9999d7e9ea588#/checkout/openButton

2. Pay the annual donation via PayPal to: racing.gta@gmail.com

3. Make check out to Tim Larsen and mail to the address below.

Send Registration & Waiver to:
P.O. Box 467 
Moretown, Vt. 05660

The waiver is required from all participants but only needs to be done the first year you register.
If you have any questions call 802-371-7535  or email  qflyer1@gmail.com