FIRC Enrollment Form

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.

Activation Code (inside blue booklet 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):	,