CMU PILOT REGISTRATION FORM This form must be completed once per year by CMU employees wishing to use private aircraft for business travel. A copy of this form must be on file with Tom Horner, Office of the Controller, prior to beginning the trip. Name: Date: Dept: Extension: Checklist: A copy of my pilot's license is attached. A copy of my airman's medical certificate is attached. A copy of my certificate of insurance, with not less than $2,000,000 combined single-limit liability coverage, is attached. My pilot's license was issued within the last 24 calendar months, or A copy of my Biennial Flight Review endorsement is attached, or A copy of my FAA Pilot Proficiency Award certificate, which doubles as a biennial flight review, is attached. Certifications (initial each one): I certify that my pilot's license and medical certificates have not been suspended or revoked. I certify that I have read the CMU policy on use of private aircraft for business travel (reprinted on the back of this form), and will conduct all flights in accordance with this policy. Signature: