Preakness Celebration Balloon Festival - May 19-21, 2011
PILOT ENTRY FORM

Pilot Name:________________________________Commercial Cert #:________________

Company Name:___________________________________

Street:_________________________________________

City:________________________ State:____________ Zip:_________

Home Phone: (______)__________________ Cell Phone:(_____)_________________

Email:________________________________________

LTA/PIC hours___________ Date of last BFR:______________

Number of crew persons you need for us to provide? __________ - Pilot's shirt size:_________

How many passengers can you carry:______; What is combined passenger weight limit: _______

$1500.00 ENTRY FEE: for Corporate Balloons. Make check payable to: Turf Valley.

Sport balloons may be required to fly two media/sponsor persons during Thursday PM OR Friday AM flight and may be asked to fly an envelope or basket banner (if available) during all planned events.
  Do you have: Velcro___Ties__ Envelope Banner size: Height_______ Width_______

INSURANCE: AGENCY:_________________________ POLICY #:________________
COVERAGE PER PASSENGER:______________ COMBINED SINGLE LIMIT:____________
POLICY LIMITS:__________________ EXPIRATION DATE:___________
REQUIRED MINIMUMS: $1,000,000.00 COMBINED SINGLE LIMIT BODILY INJURY AND PROPERTY DAMAGE; $100,000.00 PASSENGER BODILY INJURY PER PASSENGER.
Named Additional Insured will NOT be required.

BALLOON DESCRIPTION:
Year/Mfg:____________________ Model:______ N-__________
Balloon Name:_________________ Last Annual:___________
Registered Owner(if different from above):_______________________________________
ADDRESS:_________________________ City:_______________ State:_____ Zip:________

I CERTIFY THE ABOVE INFORMATION TO BE CORRECT.

pilot signature:___________________________________ date:__________

Mail this entry form, pilot requirement form, pilot bio form, copy of insurance, W9 form and appropriate fee to:
Ron Broderick, Balloonmeister -- 12465 Barnard Way, West Friendship MD 21794 - email -- 410-442-5566
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