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<H1><FONT COLOR="RED">PilotAge Subscriber Registration Form</FONT></H1>
</CENTER>
<H3>
The PilotAge On-Line Magazine subscription is
<B><FONT COLOR="RED">FREE</FONT></B> (for a limited time). Simply
fill out the form below, then press the <B>SUBSCRIBE</B> button. You
shall then be entitled to all the rights and privileges of a PilotAge
Subscriber.
<P>
Among these offerings is an email based calendar feature that will
email to you a reminder of upcoming events, such as your annual,
your pending BFR, or your medical re-examination. You select these
options by entering a date within the appropriate fields in the
form below.
<P>
<H5>
(Please allow another few days for me to write the dang calendar program.)
</H5>
<P> Subscribers are also entitled to a free Classified Ad of 19 words or less.
<!--- Following your
registration, you will be taken to the Classified Ad Form, where you
may enter your ad copy. Again, I beg your indulgence, as I will get
around to writing the Classified AD Insertion program in a day or two.
In the meantime,
--->
You may Add Your Ad by going to the FREE AD area at <A HREF="http://www.pilotage.com/forms">http://www.pilotage.com/forms</A>
and providing the requested information. You may build onto this Basic Free
Ad with more text, photos, colors, banners and links. Call 1-949-548-1969
or Email <A HREF="mailto:Max@PilotAge.com">Max</A> for particulars.
<P>
Thank You,<BR>
Don
</H3>
<P><HR>
<FORM ACTION="http://www.PilotAge.com/cgi-bin/mkgen.cgi?File=/WWW/pilotage/.data/spool.db&" METHOD="POST">
<input type=hidden name=Type value="SUBSCRIBER">
<CENTER>Fill out this Form, then Press <U>SUBSCRIBE</U>, below.
The <B>Bold</B> items are <B>Required</B>.</CENTER>
<P>
<P>
<TABLE BORDER=0>
<TR> <TD><B>Name</B></TD> <TD><INPUT NAME="Name" SIZE=30></TD>
<TD><B>Email</B></TD> <TD><INPUT NAME="Email" SIZE=30></TD>
</TR>
<TR> <TD><B>Address</B></TD><TD><INPUT NAME="Addr1" SIZE=30></TD>
<TD><B>Phone</B></TD> <TD><INPUT NAME="Phone" SIZE=30></TD>
</TR>
<TR> <TD></TD><TD><INPUT NAME="Addr2" SIZE=30></TD>
<TD><B>Occupation</B></TD> <TD><INPUT NAME="Occup" SIZE=30></TD>
</TR>
<TR> <TD><B>City,State,Zip</B></TD><TD><INPUT NAME="Addr3" SIZE=30></TD>
<TD>Airport</TD><TD><SELECT NAME="AP_id">
<OPTION>
<OPTION>3O8 --- Coalinga, Harris Ranch
<OPTION>AJO --- Corona Muni
<OPTION>AVX --- Avalon, Catalina
<OPTION>BIH --- Bishop
<OPTION>BLH --- Blythe
<OPTION>BNG --- Banning Muni
<OPTION>BUR --- Burbank, Glendale, Pasadena
<OPTION>CCB --- Cable, Upland
<OPTION>CLG --- Coalinga Muni - Old
<OPTION>CMA --- Camarillo
<OPTION>CNO --- Chino
<OPTION>CPM --- Compton
<OPTION>CRQ --- Palomar, Carlsbad, McClellan
<OPTION>DAG --- Barstow-Daggett, Daggett
<OPTION>EED --- Needles
<OPTION>EMT --- El Monte
<OPTION>F70 --- French Valley, Murrieta
<OPTION>FUL --- Fullerton Muni
<OPTION>HHR --- Hawthorne Muni
<OPTION>HMT --- Hemet, Ryan
<OPTION>IZA --- Santa Ynez
<OPTION>L06 --- Death Valley Nat'l Mon
<OPTION>L08 --- Borrego Springs
<OPTION>L09 --- Death Valley, Stovepipe
<OPTION>L12 --- Redlands Muni
<OPTION>L18 --- Fallbrook Community Airpk
<OPTION>L22 --- Yucca Valley
<OPTION>L32 --- Oceanside Muni
<OPTION>L35 --- Big Bear City
<OPTION>L39 --- Ramona
<OPTION>L45 --- Bakersfield Muni
<OPTION>L52 --- Oceano County
<OPTION>L65 --- Perris Valley
<OPTION>L67 --- Rialto, Art Scholl Field
<OPTION>L86 --- Murrieta, Bear Creek
<OPTION>L90 --- Ocotillo Wells
<OPTION>L91 --- Bakersfield, Rio Bravo
<OPTION>LAX --- Los Angeles International
<OPTION>LGB --- Long Beach, Daugherty Field
<OPTION>MYF --- Montgomery Field, San Diego
<OPTION>ONT --- Ontario International
<OPTION>POC --- Brackett Field, La Verne
<OPTION>PRB --- Paso Robles
<OPTION>PSP --- Palm Springs Regional
<OPTION>RAL --- Riverside Muni
<OPTION>RIR --- Flabob, Riverside, Rubidoux
<OPTION>RIU --- Rancho Murieta
<OPTION>SAN --- Lindbergh Field, San Diego
<OPTION>SBA --- Santa Barbara Muni
<OPTION>SBP --- San Luis Obispo
<OPTION>SDM --- Brown Field, San Diego
<OPTION>SEE --- Gillespie Field, San Diego
<OPTION>SMO --- Santa Monica Muni
<OPTION>SNA --- John Wayne, Santa Ana
<OPTION>SZP --- Santa Paula
<OPTION>TNP --- Twentynine Palms
<OPTION>TOA --- Torrance, Zamperini Field
<OPTION>TRM --- Palm Springs, Thermal
<OPTION>TRM --- Thermal, Palm Springs
<OPTION>UDD --- Bermuda Dunes, Palm Springs
<OPTION>VCV --- Victorville, So Cal Int'l
<OPTION>VNY --- Van Nuys
<OPTION>WHP --- Whiteman
<OPTION>WJF --- Lancaster, William J Fox
</SELECT></TD>
</TR>
<TR> <TD COLSPAN="2">Do you have internet access?
  Yes<INPUT NAME="Net" TYPE="RADIO" VALUE="Yes">
  No<INPUT NAME="Net" TYPE="RADIO" VALUE="No"></TD>
<TD>Your flying club name?</TD><TD><INPUT NAME="Club" SIZE=30></TD>
</TR>
<TR> <TD COLSPAN="3">Would you like to receive the FAA SoCal Safety Review
via Email?</TD>
<TD>Yes<INPUT NAME="SoCalRev" TYPE="RADIO" VALUE="Yes">
  No
<INPUT NAME="SoCalRev" TYPE="RADIO" VALUE="No"></TD>
</TR>
<TR> <TD COLSPAN="4"><HR></TD></TR>
<TR> <TD COLSPAN="2" ALIGN=CENTER>For Pilots Only</TD>
<TD COLSPAN="2" ALIGN=CENTER>For Aircraft Owners Only</TD>
</TR>
<TR> <TD COLSPAN="2">If you are a Pilot, you may enter your</TD>
<TD COLSPAN="2">If you are an Owner, you may enter your</TD>
</TR>
<TR> <TD>Rating(s)</TD><TD><INPUT NAME="Rating" SIZE=30></TD>
<TD>Make & Model</TD><TD><INPUT NAME="ACMake" SIZE=30></TD>
<TR>
<TR> <TD>Certificate #</TD><TD><INPUT NAME="PilotID" SIZE=30></TD>
<TD>"N" Number</TD> <TD><INPUT NAME="Nnumber" SIZE=30></TD>
</TR>
<TR> <TD COLSPAN="2">and your BFR date for an Email reminder</TD>
<TD COLSPAN="2">and your Annual date for an Email reminder</TD>
</TR>
<TR> <TD>BFR date</TD> <TD><INPUT NAME="BFRdate" SIZE=30></TD>
<TD>Annual date</TD> <TD><INPUT NAME="ANdate" SIZE=30></TD>
</TR>
<TR> <TD COLSPAN="2">Enter your Medical date for an Email reminder</TD>
</TR>
<TR> <TD>Med date</TD> <TD><INPUT NAME="MEDdate" SIZE=30></TD>
</TR>
<TR> <TD COLSPAN="4"><HR></TD></TR>
</TABLE>
</form></body>]]>