Student Information Before your begin . . . - There are 4 Forms Total. You will be redirected to the next after each submission. You can also use these links to access forms: 1. Student Information 2. Waiver of Liability 3. Statement of Medical Condition 4. Insure Your Trip - It will take about 20 minutes to complete these forms. 🕑 - All fields are required. Please type N/A if any field is not applicable. ☑ - Info & File Attachments: Please review this form before beginning. You'll need your Logbook(s) and Current Photo ready for important info, and to attach at the end of this form. ☑ 1 of 4: Student Information Form Your Course Starting Date Training Location (Las Vegas, NV or Anchorage, AK) Your Name Date of Birth (i.e. Februayr 1, 1990) T-Shirt Size Are you currently IRATA certified? YesNo Current IRATA Level Current IRATA Number Current IRATA Expiry Date Logbook Serial # Total Logged hours Logged at current level Lost Log Book?* YesNo *Technicians must have their logbooks present for training and assessment. Lost logbooks need to be replaced in advance of the course date. See IRATA TACS 4.13 for more clarification. Are you currently SPRAT certified? YesNo Current SPRAT Level Current SPRAT Number Current SPRAT Expiry Date Total Logged hours Logged at current level Desired IRATA Level —Please choose an option—N/A123 Desired SPRAT Level —Please choose an option—N/AIIIIII Mailing Address: Street City State Zip Code Phone Can we text you at this phone number? YesNo Your Email (required) Emergency Contact Name Emergency Contact Phone Employer Employer Phone Trade Qualifications Work at Height or Recreational Experience Please attach your Logbook file. Please attach your current photo.