WORLD DISTANCE AWARD

DISTANCE SUMMARY SHEET 

DATE: ______________                                        SSA No.:_________________

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 believe that this pilot is being honest about making all of the flights claimed and claiming that these flights meet the requirements outlined in the WDA Guidelines. 
The total distance claimed is resonable.

___________________________       _________________________   ____________
 SSA Member Name (Printed)	                         Signature	                      Date
 
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:

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

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

Revision date:  Nov, 2004                                                                                              filename:  WDA-DistSum.rtf