WORLD DISTANCE AWARD

REGISTRATION FORM

SSA MEMBERSHIP 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:

Duane Eisenbeiss, WDA Administrator
507 N Maple St
Prospect Hts,  IL  60070

Telephone: 847-259-5418                   e-mail: eisenbeiss@compuserve.com

Revised:  Jul, 2004                                                          filename:  WDA-regis.rtf