WORLD DISTANCE AWARD

DISTANCE SUMMARY SHEET

DATE: ______________SSA No.:_________________
PILOT'S NAME:
PILOT'S NAME:_______________________________________________
ADDRESS:_______________________________________________
_______________________________________________
PHONE NUMBER:_______________________________________________
EMAIL:_______________________________________________
PERIOD OF THIS SUMMARY:_______________________________________________
DISTANCE CLAIMED THIS SUMMARY SHEET:____________________________________________ KM
YOUR CALCULATION OF NEW TOTAL DISTANCE:____________________________________________ KM
  
As pilot, I certify that the distance I am claiming is from flights that meet the requirements as outlined in the WDA Guidelines
  
PILOT SIGNATURE:_______________________________________________
  
  
I certify that I have reviewed the flight log and, where applicable, contest score All of the claimed flights meet the requirements as outlined in the WDA Guidelines. The total distance claimed is accurate.

_____________________________________________________________________________
SSA Member Name (Printed)SignatureDate

Submit Distance Summary Sheet when each 5000 km level is achieved OR at the end of each year.  NOTE: Flights used must be less than one year from submittal date.

Send Distance Summary Sheets to:

Revision date: Oct, 2006filename: WDA_Distance_Summary.html

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Please contact John Leibacher with any suggestions concerning this material.