You are on page 1of 1

26

Manitoba Conservation
Lasl Name: First Name lnitials

Confidential Pilot lnformation


uompany:

Campbell Helicopters Ltd.


FW License #
:

RW License #

Engineer License #

PPC Due Date

Medical Due Date

LICENSE

DATA

(P|-),'iSE tndicure if!:-ed tttng or rotar.t u'ing or

hoth FL*'or RW or B7TH)

TYPE

ENDORSEMENTS

FLYING EXPERIENCE
Aircraft by Make/Model
ie: Bell 205

Aircrafl T

and Model)

SPECIALTY FLYING EXPERIENCE


lJ u L

lEstinarerl hours t{trarnins and experience, und the date taintns rcceived no,.,r)
.\///?ljrrg

k,'t il !: fu
t

tnt h

)1

7.1

l,ong Lntng

l)ottgarutt.s(iurxl.t

I
I

.\ur!,l,

lanril Sfru)'tuN

DECLARATION
I certify that lhe information entered on this form js true to the best of my knowledge and

beljef

Prlot Signaluro

Operations {anager
Ernployer Srgnature
Title

You might also like