Eurocopter Canada Limited - Support - Training Centre Enrollment Form

TRAINING CENTRE ENROLLMENT FORM

This form must be completed, printed out, and faxed to Eurocopter Canada as follows:

Maintenance Training - (905) 871-3599 , attention: Mario Blais
Pilot Training - (905) 871 3599, attention: Claude Roy

Upon enrollment into all training courses, an open purchase order or credit card is required from all customers within 10 working days before the class start date. Cancellation of enrollment received more than 10 working days before the class will avoid tuition assessment. Cancellations received between 5 and 10 working days before class date will be assessed 25% of full tuition. No-shows and cancellations received less than 5 working days before class date will be assessed 50% of full tuition charges for the class.

ALL CANCELLATIONS MUST BE IN WRITING.

Last name, first name:

Nationality:

AME/Pilot License #
or School Attended:

Company:

Address:

City: Prov/State:

Postal Code:

Work Telephone: - Ext.

Home Telephone: -

Fax Number: -

E-Mail Address:

Course Title(s) - Airframe / Engine:

Start Date(s) - - Airframe / Engine:

Purchase Order Number:

Course provided under Purchase Agreement; aircraft serial number:

Credit Card Number:

Card Type: Amex Visa MasterCard

Expiry Date MM / YY