AGS Aircraft Dispatcher Training Course Registration Form

Airline Ground Schools
Aircraft Dispatcher Training Course
REGISTRATION FORM
(Click "Print" on your Browser to print this form)
Mail to: AGS, 73 Cavalier Blvd. #216, Florence, KY 41042 or FAX 859-371-3643

STUDENT

EMERGENCY CONTACT

FAMILY OR SURNAME

FIRST NAME

RELATIONSHIP

Born in City / Country:

ADDRESS

ADDRESS

CITY

STATE

ZIP

CITY

STATE

ZIP

PHONE

E-MAIL

PHONE

COURSE: ¨ Full 13 weekend                            ¨ 3 Weekend Correspondence

              ¨ 6 Day Correspondence                  ¨ Memphis                         ¨ Other

Requested class start date: ____________________ or place me in an "Uncommitted Status" at this time

LICENSES: TOTAL FLIGHT TIME: _________

FAA License # ______________________

¨ PRIVATE               ¨ INSTRUMENT

¨ COMMERCIAL      ¨ CFI                  ¨ ATP

¨ OTHER (SPECIFY)
Date of Birth: _________________________
Foreign Students: We assume you will be traveling alone to the US. If you are accompanied, we must know the names of those coming & their relationship to you.

INSTRUCTIONS: This registration form must accompany your $500 non-refundable deposit which is credited toward the course fee. Below is a checklist to assist you in our registration procedures.

¨ I REQUEST HOUSING INFORMATION

¨ I REQUEST FINANCIAL ASSISTANCE INFORMATION (US Residents only)

¨ CIRCLE YOUR PREFERENCE: CINCINNATI, OH (CVG) , MEMPHIS, TN (MEM)

¨ ATTACHED IS A 1 PAGE RESUME DETAILING MY AVIATION EXPERIENCE

¨ ENCLOSED IS A $500 NON-REFUNDABLE DEPOSIT. PLEASE ENROLL ME.

¨ ENCLOSED IS A PHOTOCOPY OF MY DRIVERS LICENSE or PASSPORT; & any aviation licenses.

Aircraft dispatching is a highly technical profession, requiring quick decisions regarding complex matters affecting flight safety and of great economic consequence.

This course has been designed to qualify a person with no prior training or experience for this demanding profession. The course is challenging and the learning is built on the foundation of the early lessons. In signing this registration form you acknowledge your responsibility to study in a manner consistent with the standards of a professional in the airline industry. This course includes considerable self-study. Further, you acknowledge that the second failing grade on any written exam voids all agreement between you and AGS and thereafter, your continued training or any refund of tuition is at the discretion of the school.

The student certifies that he/she can read, speak, write, and understand the English language.

____MasterCard ____ Visa ____ AMEX: Card #_________________________Expires_________ I hereby authorize

AGS to charge my card a $500 registration. Signed _________________________

Date _________________

The balance of your fee is due in 8 days before class to confirm your reservation. Until then, you are not
liable for any fees other than the $500 non-refundable registration fee.

You may e-mail the registration form to us at agsdanny@aol.com by downloading and saving
the MSWORD DOC file AGS_FORM.

Please type "AD Registration" on the subject line or you may fax it to 859-371-3643

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Last updated 06/09/2008

STUDENT			EMERGENCY CONTACT
FAMILY OR SURNAME			FIRST NAME	RELATIONSHIP
Born in City / Country:
ADDRESS			ADDRESS
CITY	STATE	ZIP	CITY	STATE	ZIP
PHONE E-MAIL			PHONE
COURSE: ¨ Full 13 weekend ¨ 3 Weekend Correspondence ¨ 6 Day Correspondence ¨ Memphis ¨ Other Requested class start date: ____________________ or place me in an "Uncommitted Status" at this time
LICENSES: TOTAL FLIGHT TIME: _________ FAA License # ______________________ ¨ PRIVATE ¨ INSTRUMENT ¨ COMMERCIAL ¨ CFI ¨ ATP ¨ OTHER (SPECIFY)			Date of Birth: _________________________ Foreign Students: We assume you will be traveling alone to the US. If you are accompanied, we must know the names of those coming & their relationship to you.

INSTRUCTIONS: This registration form must accompany your $500 non-refundable deposit which is credited toward the course fee. Below is a checklist to assist you in our registration procedures.
	¨ I REQUEST HOUSING INFORMATION
	¨ I REQUEST FINANCIAL ASSISTANCE INFORMATION (US Residents only)
	¨ CIRCLE YOUR PREFERENCE: CINCINNATI, OH (CVG) , MEMPHIS, TN (MEM)
	¨ ATTACHED IS A 1 PAGE RESUME DETAILING MY AVIATION EXPERIENCE
	¨ ENCLOSED IS A $500 NON-REFUNDABLE DEPOSIT. PLEASE ENROLL ME.
	¨ ENCLOSED IS A PHOTOCOPY OF MY DRIVERS LICENSE or PASSPORT; & any aviation licenses.