2009 Air Crew Survival Training
REGISTRATION APPLICATION / RELEASE OF LIABILITY FORM
Personal Data:

Name __________________________________Phone (       )_________________cell

Address _______________________________________________________________

City_____________________________________State________  Zip_______________

Organization ____________________________________________________________
 

Emergency Information:

Notify  ______________________________Relationship _________________________

Address  ___________________________   Phone       ___________________________

Medical Alert           ________________________________________________________

Allergic Reactions    _______________________________________________________

Prescriptions            _____________________________Other ______________________

RELEASE OF LIABILITY / ASSUMPTION OF RISK:

As you are aware, there are obvious risks in most active survival training
courses. During training, emergency situations that arise as a result of site
conditions or application of instructional techniques cannot always be
anticipated. We make every attempt to reduce this risk and uphold a
level of expectation that safety parameters are implemented and
maintained at all times. The instruction provided in this type training
is intended as a guideline in how to handle a similar situation, but cannot
address every response circumstance encountered during an
emergency. Participant understands and assumes all risks associated
with the training and its use by signing below.

Signature________________________________________Date _______________

E-mail     _____________________________________________________________

***Number of ACS T-shirts  ________ $12.00 each

***Sizes ________________________________________________ 
              Please include T-shirt cost with application payment. 

***Application must be received prior to March 1 in order to insure t-shirt purchase.
    Please do not include t-shirt payment after March 1

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2009 Air Crew Survival Training
March 14 &15, 2009
 

Huntingburg Airport
Huntingburg, Indiana
N38* 14.93'
W86* 57.47'

Saturday 07:30-08:00 a.m. Check-In 
8:00 am - 3:30 p.m. Classroom Training

Overnight Survival Scenario

Sunday 7:00 a.m. - 9:30 am.
 Breakfast,Debreifing and Review

Some Facts about the 2009 Air Crew Survival Training

1. If a large group is planning to attend the ACS training, please contact one 
of the following people for more information. (Space is limited to 25 students) 

2. There will be a $110.00 registration fee for all personnel attending the 
ACS training, which is due by March 1, 2009

If you would like to order a (ACS) T-shirt please add $12.00 to the total for 
each shirt ordered, please include needed size below ***

Make checks payable to: 2009 ACS Training (OVSAR)

Send payment and  OVSAR
Application to:             P. O. Box 2486
                                      Evansville, IN 47728-0486

Contact:  a. Cliff Weaver      (812) 483-7400   evvfire@evansville.net  or
                 b. Linda Dillbeck  (812) 454-2905  dillbeck105@gmail.com

1. Meals will be provided, if you are on a special diet, please bring your own 
    provisions. 
2. All personal attending the outdoor exercises will need appropriate clothing 
    and safety equipment during training, (Flashlight with extra batteries, boots, 
    long sleeve shirt, long pants, water, etc).
3. A release of liability form must be completed by anyone before participating 
    in any training activities.
4. There will be absolutely no alcohol or firearms allowed on the premises 
    during the training. 

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