VIA AIR, Inc.
N.E. Phila Airport
Grant Ave & Ashton Rd
Phila., Pa. 19114-1094
215-677-3377
www.FlyViaAir.net

 Student Application
Print out this application, fill it out and bring it with you to your first lesson.
Note: Bring proof of U.S. Citizenship for your first flight. If you are not a U.S. Citizen then you must submit to a background check first. Proof of citizenship can be a U.S. Birth Certificate or U.S. Passport.

Today’s Date: __________

Name: ____________________________

Address: ___________________________________

Address: ___________________________________

City: _______________ State: _____ Zip: ___________

Phones:

Home: _______________ Work: _______________

Cellular: ________________ Pager: _______________

Other : ____________________ Emergency: ____________________

E-mail: ______________________________

Date of Birth: _______________ Age: _________

Education: _______________________________________________________

How did you learn about Via Air?: _________________________________________
If it was the Internet can you be more specific such as a "search" or through AOPA’s web page?
____________________________________________

Aviation Goals:         Pleasure Flying        Career Flying         Other: ___________________

Current Ratings - if any: __________________________________________________

Aviation Experience: _____________________________________________________

Credit Card (see note below): _____________________________  Exp: ____________
Without a credit card on file you will not be permitted to have a negative balance or rent videos. Each lesson or rental MUST be paid at the time of completion. You will not be permitted to put items on your Via Air account.