WORLD DISTANCE AWARD

REGISTRATION FORM

SSA No.:_________________
PILOT'S NAME:_______________________________________________
ADDRESS:_______________________________________________
_______________________________________________
PHONE NUMBER:_______________________________________________
EMAIL ADDRESS:_______________________________________________
  
I wish to participate in the World Distance Award program.   I am a current member of the Soaring Society of America.   I certify that I will only submit distance totals for flights which have been accomplished in accordance with the Guidelines for the World Distance Award and that each flight will be countersigned as described in the WDA Guidelines.
  
___________________________________ ________________
(Pilot's signature) (Date)

The one-time registration fee of $20.00 (payable to SSA) is enclosed.   I understand there will be no fee for certificates, but the ring signifying WDA completion (40,000 km accumulated distance) will be made available for a nominal cost.

Administrator's Record: Check No: ____________ Date received: __________________
Date Mailed to SSA: __________________

Send Registration, Registration Fee, and Flight Summary Sheets to:

Revision date: Oct, 2006filename: WDA_Registration.html

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Please contact John Leibacher with any suggestions concerning this material.