I. COMPANY/AIRCRAFT INFORMATION:
Name of Company: _Alaska Airmen’s Association, Inc.__________________________
Mailing Address: _4451 Aircraft Dr. #G________________Anchorage, AK_______________99502__
Street Address City/State Zip Code
Company Telephone No.: __907-245-1251________ Company Fax No.: __907-245-1259_______________
Purpose of Flight: ____Demonstration Flight extending Int’l VFR Route B-369 ________________
Please specify whether flight is Cargo, Passenger or Both _Not Applicable/General Aviation/Pleasure Flight
Name and Telephone Number of Requestor: __Mona Holmes, Alaska Airmen’s Assoc., 907-245-1251___
Flight Itinerary: REQUEST WAIVER TO OPERATE TO/FROM AND WITHIN THE UNITED STATES
Type of Aircraft __Cessna T210M______________ Aircraft Call Sign _______N498TB_______________
State of Aircraft Registry & Tail No. ___Alaska, N498TB___________________________________________
Aircraft Maximum Certified Takeoff Gross Weight: ______4000 lbs________________________________
II. CREW AND PASSENGER INFORMATION:
(Note: Place of Birth, if US City and State, if Foreign City and Country)
|
Last Name |
First Name |
Middle Name |
Date of Birth (yyyymmdd) |
City/Country of Birth |
Passport Number (Use Text Format) |
Passport Country of Issuance |
If US provide Green Card # and/or SSN |
|
Bureau |
Todd |
Marvin |
|
Wooster, OH / USA |
|
|
|
|
Skogstad |
James |
|
|
Helena, MT / USA |
|
|
|
|
Maguire |
Felix |
Michael |
|
Dragheda, Ireland |
|
|
|
|
Holmes |
Ramona |
Teresa |
|
SF, CA /USA |
|
|
|
III. FLIGHT ITINERARY:
List all legs of flight (4 letter identifiers only) with dates of travel: (Ex: Feb 14 – 23. KMIA-LFPB-KMIA)
__ Aug 01-04, 2004 PAOM-UHMD-UHMA-UHMD-PAOM (Request alternate dates in event of weather/mechanical issues: Aug 04-06, 2004) ___________________________________________________________________________________________________________________________________________________________
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SECURITY STATEMENT
Aircraft Registration Number: ____N489TB_________
Type of Aircraft: ____Cessna T210M___
I. AFFIRMATION: Requestor/Signature must affirm to each of the following:
(Please check (X) each criteria)
_X____ Access to aircraft has been properly controlled by company representatives.
_X___ A senior company representative has verified the identity and authorization of each crewmember and passenger.
_X___ Only authorized passengers are on board the aircraft.
_X___ The aircraft will not deviate from the approved air traffic flight plan.
_X___ The pre-flight inspections include a search of the cargo and cabin areas to ensure no foreign objects, explosives, etc. have been placed on board.
II. How is the aircraft secured when not operational? (locked hangar, fenced area with gate access, security guards, etc…)
Fenced area with gate access, airport security
III. How are the personnel on board vetted/positively identified/security reviewed before boarding the aircraft?
All are personally known to pilot/owner and all are members of Alaska Airmen’s Association, Inc.
IV. Additional security measures taken (if any) are:
Pre-flight briefing and knowledge of international regulations.
V. SIGNATURE OF CORPORATE SECURITY DIRECTOR, COMPANY PRESIDENT, EQUIVALENT OR DESIGNEE.
___________________________________________Administrative Manager/Alaska Airmen’s Association
Signature Title
______7-12-04_______________________________907-245-1251____________________________________
Date Contact Number
Fax completed forms to (571) 227-1945
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