AGS Aircraft Dispatcher Training Course Registration Form

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

Last Name, First name

EMPLOYER

CITY & COUNTRY OF BIRTH ____________________________________________

DATE OF BIRTH ______________________________________________________

Country of Citizenship __________________________________________________

Male or Female _____________

EMERGENCY CONTACT

NAME

RELATIONSHIP

ADDRESS

ADDRESS

CITY

STATE

ZIP

CITY

STATE

ZIP

PHONE

E-MAIL

PHONE

COURSE: ¨ 6 Day   ¨ 13 weekend       ¨ Memphis   ¨ Other ¨ Uncommitted at this time.

Requested class start date______________________________

FAA License # _____________________     Flight hours _______

¨   PRIVATE                                           ¨   CFI

¨   INSTRUMENT                                  ¨   ATP
The balance of your fee is due 8 days before class to confirm your reservation. Until then, you are not liable for the balance.

INSTRUCTIONS: This registration form must accompany your $500 check which is credited toward the course fee (made payable to AGS). Here is a checklist to assist you in registration.

¨ I REQUIRE HOUSING INFORMATION

¨ I will attend     ¨ CINCINNATI (CVG);      ¨ Memphis (MEM) or      ¨ (______)    other city if different

¨ ATTACHED IS A 1 PAGE RESUME DETAILING MY WORK EXPERIENCE

¨ For survey purposes, please indicate if you have a 4 year college degree (This is not a FAA requirement).

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

Aircraft dispatching is a highly technical profession, requiring quick decisions regarding complex matters affecting flight safety and with great economic consequence. This course has been designed to qualify an individual with no prior training or experience for entry into this demanding profession. The course is complex and learning is built on the foundation of the earlier lessons. In signing this document you acknowledge the responsibility to study in a manner consistent with the standards of a professional in the airline industry. This will require considerable self-study. Further, you acknowledge that the second failing grade on any written exam voids all agreement between you and this school and thereafter, your continued training or refund of tuition is at the discretion of AGS. The refund policy is described in the Course Catalog.

The student certifies that he/she can read, speak, write and understand the English language.                                               Student acknowledges that AGS cannot guarantee jobs. Foreign students: AGS assumes you will be traveling alone to the United States. If you are accompanied we must know their names and relationship to you.

STUDENT SIGNATURE: DATE:

___MasterCard ___Visa   ___AMEX       Card #__________________________________     Expires _______________

I hereby authorize AGS to charge my card $500 for registration. Signed______________________________________

Received and reviewed this date. Student   is / is not   accepted into the program.

SCHOOL OFFICIAL: _________________________________________________________________        DATE:

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 10/16/2008

Last Name, First name			EMPLOYER
CITY & COUNTRY OF BIRTH ____________________________________________ DATE OF BIRTH ______________________________________________________ Country of Citizenship __________________________________________________ Male or Female _____________			EMERGENCY CONTACT NAME	RELATIONSHIP
ADDRESS			ADDRESS
CITY	STATE	ZIP	CITY	STATE	ZIP
PHONE E-MAIL			PHONE
COURSE: ¨ 6 Day ¨ 13 weekend ¨ Memphis ¨ Other ¨ Uncommitted at this time. Requested class start date______________________________
FAA License # _____________________ Flight hours _______ ¨ PRIVATE ¨ CFI ¨ INSTRUMENT ¨ ATP			The balance of your fee is due 8 days before class to confirm your reservation. Until then, you are not liable for the balance.

INSTRUCTIONS: This registration form must accompany your $500 check which is credited toward the course fee (made payable to AGS). Here is a checklist to assist you in registration.
	¨ I REQUIRE HOUSING INFORMATION
	¨ I will attend ¨ CINCINNATI (CVG); ¨ Memphis (MEM) or ¨ (______) other city if different
	¨ ATTACHED IS A 1 PAGE RESUME DETAILING MY WORK EXPERIENCE
	¨ For survey purposes, please indicate if you have a 4 year college degree (This is not a FAA requirement).
	¨ ENCLOSED IS A PHOTOCOPY OF MY DRIVERS LICENSE or PASSPORT; and any aviation licenses.