Proficiency Training
Program
January 1, 20__ to
December 31, 20__
Name:
___________________________________________________________
Ninety-Nines_Chapter:
______________________________________________
Phone:____________________________________Email:_______________________
Qualifying
Activities:
Flight
Activity Type:___________________Ground Activity Type: ____________________
Date:
______________________________ Date:________________________________
Instructor
Signature: __________________Instructor Signature:___________________
(Return completed form to chapter's Proficiency Training Coordinator for processing)
Sherlyn Halloran
408 W. Adamanda
Phoenix, AZ 85086-2401
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