Aviation Discovery Weekend 2012 Pre-Registration Form

The Worcester Regional Flight Academy
Swissport Building
375 Airport Drive
Worcester, MA 01602
774-287-4180
http://www.worcesterregionalflightacademy.com

Thank you for your interest in the Aviation Discovery Weekend! Please fill out the basic information in this form in order to reserve a place today. Please submit this form ONLY if you will be remitting a down payment with the 4-page enrollment form within TWO WEEKS of this pre-registration in order to complete your reservation. Once we receive this information we will contact you within two business days in order to discuss your child's interest and answer any other questions you may have. Once again, thank you for your interest and we look forward to being a part of your summer activities!

Student Information

First Name

Last Name

Gender

Birth Date

Grade

* Which discovery session do you wish to attend?

August 10-12

Household / Adult Primary Contact

* Relationship to Student:

Mother

Father

Guardian

Other

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Zip

Phone

Alternate Phone

* Email Address

* How did you hear about us?

* Indicates Response Required


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