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Pilot Application

Thank you for your interest in joining Pilots For Patients as a member. We look forward to welcoming you to our very special family of volunteers.

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We welcome anyone as a Pilots For Patients pilot; however, please be aware that there are certain minimum qualification requirements for pilots who fly missions. If you would like to become a volunteer pilot, please download, print, fill out the Volunteer Pilot Application Form Adobe Reader, and please mail or fax to the Pilots for Patients office.

You may also fill in the following online application form below and mail or fax to (318 388 4924) the necessary documents later at your convenience.
NOTE: Additional personal information is needed on the printable version, which is not included on the online application.

If you have any questions or would like information about becoming a volunteer pilot of Pilots For Patients not covered on this web site, you can contact us here.

Personal Information
Name: (First, Last)

*First: *Last:

 Company/Title:


*Address:


*City: *State: *Zip:
*Home Phone: Work Phone: Fax:
Mobile Phone: Pager: Other:
*Email:


Pilot Information
*Certificate Number(s):

*Medical Class: *Exam Date: *Date of last BFR:
Certificates & Ratings Held:
Pvt   IFR   COM   ATP   CFI   CFII   Other

Flight Hours
*Total:   *Single Engine:   *Multi-Engine:   *Instrument:   *Night:  
              

Airport Information
Please list only the airport from which you fly most frequently
*I Fly From:   *State:   *Airport Identifier:  

*For PFP flights, consider me a:
Pilot  
For PFP listing we consider a "Pilot" to be an aircraft owner, renter, or someone who has access to an aircraft and is willing to pay the expenses associated with the flight.
Aircraft Information
Complete this section only if you have a specific aircraft available for PFP flights
Make:
Model:
N-Number:
   
   
Engine:   Single   Twin
Cruise Speed:   
Seats:    A/C Colors:
       
Special Equipment:

Mission Information
Please read the following carefully and fill in the applicable information. If you have any questions, please contact us.

PFP member pilots fly two basic types of missions. The first is to recover donor organs and the second is to transport needy patients and their traveling companions.

Most organ recovery flights are flown late at night (after 11:00pm), when there are no commercial flights available. Please check, if you are willing to receive phone calls and fly late at night.

Please check if you are willing to fly on missions transporting patients and their traveling companions.

Miscellaneous Information
If you have any further information or comments, please let us know:


* I have read and understand the operational guidelines set forth by the Pilots For Patients (PFP). In accepting a referral from Pilots for Patients, I agree to provide transportation at no cost to those we serve. When I accept a referral, I do so as a volunteer pilot, not as an agent, servant or employee of Pilots For Patients. I will only accept a referral, provided that all my applicable pilot certificates and medical certificate are current and valid and I meet all recent flight experience requirements for such flight(s). I agree to abide at all times by all applicable Federal Aviation Regulations in the conduct of the flight, and to provide transportation in an airworthy aircraft, as defined by the Federal Aviation Regulations. In addition, I certify that before accepting any referral, I will have in force a liability policy covering myself and my aircraft for not less that $1,000,000. I recognize that I am considered as Pilot in Command and that all decisions with regard to any flight conducted by me are mine alone, and I agree to always remember that safety comes first. In accepting a referral and in providing transportation, I release, indemnify and hold harmless Pilots For Patients from any liability that might arise from my actions.
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