FIRC Enrollment Form

Activation Code (inside FIRC Book cover):
Desired Login:
Desired Password:
First Name:
Middle Name:
Last Name:
Street: 1
City:
State:
Zip:
Country:
Home Telephone:
Work Telephone:
Email Address
Flight Instructor Certificate Number:
Flight Instructor Certificate Expiration Date (example):	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

I agree to study and be the sole completor of all required test materials and will complete the course as intended.

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Notes

• All fields except 'Middle Name' are required.
• You will be supplied with a 25 character activation code when you purchase the FIRC.
• Login names should consist of alphanumeric characters (a-z, A-Z, 0-9) only.
• ¹ Use your permanent, home address (the address the FAA has on file for you).
• If your flight instructor certificate has already expired, you cannot use this FIRC to reinstate your license; however, you may take the FIRC for continuing education purposes and receive a Certificate of Completion.