Flight Training Request Form Step 1 of 6 - Terms and Conditions 16% HiddenJob ID# The information provided in the registration is a truthful and accurate You acknowledge and agree that Cirrus Aircraft will retain the details of flight training and shall have the right to disclose any and all such information to relevant authorities including the FAA. You represent that you are a licensed pilot with a current medical. You represent that your Cirrus aircraft to be used for flight training in legal, airworthy condition. By signing below certify that the Aircraft to be used is in compliance with FAR 91, Subpart E (Maintenance, Preventive Maintenance and Alterations). You acknowledge and agree that fees for any additional training (beyond the training provided by Cirrus under this Program) provided by your flight instructor will be your responsibility. You have read the Terms and Condition provided on https://cirrusaircraft.com/embark/. You agree to indemnify and hold Cirrus Aircraft, its parent company, shareholders, officers, directors, employees and agents harmless from and against any and all claims, losses, liability, damage and expense arising out of or in any way connected with the use of your furnished aircraft, including but not limited to loss of (including loss of use) or damage to the Aircraft itself. You also agree to waive your rights of subrogation against Cirrus Aircraft. You represent and warrant that you shall carry a minimum of One Million Dollars ($1,000,000) of combined single limit aircraft liability insurance coverage, and hull insurance coverage in an amount sufficient to cover the purchase price of the Aircraft. You shall also cause your hull insurance carrier waive rights of subrogation against the Cirrus Aircraft, the CTC and the CSIP and each of their respective shareholders, officers, directors, employees and agents. It is agreed that the insurance mentioned above will include CSIP or CTC pilots as approved pilots and be primary and non-contributory to any other insurance available to Cirrus Aircraft, the CTC or CSIP as an insured or otherwise. Prior to your 1st day of Embark Training you must provide Cirrus with a Certificate of Insurance evidencing the insurance coverages outlined in this paragraph 8. Failure to provide such evidence shall prevent you from receiving Embark Training. All pilot services or classes provided by Cirrus Aircraft or its instructors are subject to any delays or interruptions that are due to force majeure conditions due to causes beyond Cirrus Aircraft's reasonable control, including, but not limited to, acts of God, fire, floods, accidents, adverse weather, breakdown of machinery, illness, shortage of materials, or compliance with any law, regulation or order of a governmental agency. Cirrus Aircraft reserves the right to notify you of the occurrence of any force majeure condition that, in its sole discretion, is the cause of such excusable delay. In the event of a force majeure condition, the services and/or classes will be extended or, if required, rescheduled for the first available opening. Cirrus Aircraft will not be liable for any costs, claims, or damages to you arising from delays or interruptions caused by any force majeure condition You acknowledge and understand that the Cirrus Aircraft pilot instructor's time is valuable, if you are unable to participate in your scheduled training session, you must provide Cirrus Aircraft and your pilot instructor with at least 24-hour notice. Any training session cancellations received with less than 24-hours notice shall be forfeited. The failure of Cirrus Aircraft to enforce any provision or condition contained herein at any time shall not be construed as a waiver of that condition or provision nor shall it operate as a forfeiture of any right of future enforcement of such condition or provision. Photo Consent: You hereby consent to the unrestricted use of photographs of You, whether taken by Cirrus Aircraft or any of its subsidiaries or affiliates during any training program for purposes of advertising, promotion, trade or art purposes. You hereby release Cirrus Aircraft from any and all liability for claims and/or demands arising out of Cirrus Aircraft's use of such photographs. These Terms and Conditions are governed by and construed in accordance with the laws of the State of Minnesota, USA without recourse to choice of law statutes or principles that would otherwise result in the application of the law of any other jurisdiction to these Terms and Conditions, regardless of its place of execution or performance. By providing my contact information herein, I authorize Cirrus Aircraft to share personal, non-financial, information about me or my aircraft with third party partners engaged by Cirrus Aircraft to provide services on behalf of Cirrus Aircraft. The personal information will not be sold or utilized in ways other than to improve your Cirrus Life experience. By signing below, I acknowledge that I have read this Agreement and its Terms and Conditions. This Agreement supersedes any prior agreements between the parties related to the subject matter of this Agreement, and may not be changed except in writing executed by both Parties.Terms & Conditions Consent* By checking this box you agree to the terms & conditions above.Signature* Name* PrefixDr.Mr.Ms.Mrs.MissProf.Major Prefix First Last Email* Phone Number*If international, please include international code.Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code --AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Airport* 3 to 4 characters required Recognized ICAO code e.g. 3M0, KTYSHow did you learn about Cirrus Embark?*Aircraft InsurerCirrus Pilot/OwnerCOPADealer/BrokerFlight InstructorMagazineWebsiteOtherHow did you learn about Cirrus Embark? (Other)*Ownership Role*Owner PilotOwner Non-PilotNon-Owner Professional PilotGroup Flying ClubPlease inform your Professional Pilot to fill out the Cirrus Embark application as well.Please inform the aircraft's Owner to fill out the Cirrus Embark application as well.Designated Pilot's Name* Provide your designated pilot's name with whom you wish to qualify for Cirrus Embark training.Aircraft Owner's Name* Provide the owner's name that you fly for professionally. Pilot Certificate*Student PilotPrivate PilotCommercial PilotATPAre you instrument rated?*NoYesAre you instrument current?*NoYesDate* MM slash DD slash YYYY Have you piloted a Cirrus Aircraft before?*NoYesSR20 Flight Hours*Enter how many flight hours you have for this aircraft model.SR20 Recency of Experience*SR20 Recency of ExperienceWithin last 12 months1-3 Years3+ YearsWhen was the last time you piloted this aircraft model?SR20 Avionics Package*SR20 Avionics PackageGarmin Perspective Touch+Garmin Perspective+Garmin PerspectiveAvidyne R9Avidyne EntegraOtherSR20 Avionics Package (Other)* SR20 Powerplant*SR20 PowerplantContinental MotorsLycoming EnginesSR22 Flight Hours*Enter how many flight hours you have for this aircraft model.SR22 Recency of Experience*SR22 Recency of ExperienceWithin last 12 months1-3 Years3+ YearsWhen was the last time you piloted this aircraft model?SR22 Avionics Package*SR22 Avionics PackageGarmin PerspectiveGarmin Perspective+Avidyne R9Avidyne EntegraOtherSR22 Avionics Package (Other)* SR22T Flight Hours*Enter how many flight hours you have for this aircraft model.SR22T Recency of Experience*SR22T Recency of ExperienceWithin last 12 months1-3 Years3+ YearsWhen was the last time you piloted this aircraft model?SR22T Avionics Package*SR22T Avionics PackageGarmin PerspectiveGarmin Perspective+OtherSR22T Avionics Package (Other)* SR22TN Flight Hours*Enter how many flight hours you have for this aircraft model. (Turbo Normalized model last produced in 2010)SR22TN Recency of Experience*SR22TN Recency of ExperienceWithin last 12 months1-3 Years3+ YearsWhen was the last time you piloted this aircraft model?SR22TN Avionics Package*SR22TN Avionics PackageGarmin PerspectiveAvidyne R9Avidyne EntegraOtherSR22TN Avionics Package (Other)* HiddenAvionics Package Hours (Perspective/Perspective+)HiddenAvionics Package Hours (Avidyne Entegra)HiddenAvionics Package Hours (Avidyne R9)Please enter a number greater than or equal to 0.Total Cirrus Flight Hours Ownership type?*Sole OwnerCo-OwnedFlying ClubFlight SchoolCharter CompanySelect total number of owners*2345+Co-Owner's Names*First NameLast Name Are you already in possession of the aircraft?*NoYesAircraft purchase price?Aircraft purchase price comments?Date of Purchase MM slash DD slash YYYY When do you expect delivery (physical possession) of the aircraft?* MM slash DD slash YYYY When would you like to start flight training?*At time of deliveryWithin 7 days of delivery1 to 2 weeks after delivery3+ weeks after deliveryWhen would you like to start flight training?*Within the next 7 daysIn the next 1 to 2 weeksIn the next 3+ weeksWhere do you expect delivery (physical possession) of the aircraft?* City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Delivery Airport* 3 to 4 characters required Recognized ICAO code e.g. 3M0, KTYSProof of ownershipUpload File(s)I will provide proof of ownership prior to training.Proof of ownership documents* Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 50 MB, Max. files: 4. Aircraft Registration*Provide Date of RegistrationProvide registration laterDate of Registration* MM slash DD slash YYYY Primary use of aircraft?* Personal Business Flying Club Charter Flight Instruction Model*SR20SR22SR22TSR22TNNote: SR22TN is the Turbo Normalized model last produced in 2010Generation*G7G6G5G3Pre G3Powerplant*Continental MotorsLycoming EnginesAvionics*Garmin PerspectiveGarmin Perspective+Avidyne R9Avidyne Entegra6-Pack (Steam Gauges)Note: Perspective+ was first released in 2017Anti-Icing System*NoneFIKINo Hazard (TKS)List any aircraft aftermarket upgradesTail Number* Serial Number* Hobbs Hours*Please enter a number greater than or equal to 0.Flight Hours*Please enter a number greater than or equal to 0.Last Annual Inspection*Provide DateDo not knowLast Annual Inspection Date* MM slash DD slash YYYY Last CAPS Repack*Provide DateDo not knowLast CAPS Repack Date* MM slash DD slash YYYY Source of purchase*Private SaleDealer/BrokerOtherDealer/Broker Name*AeristaLone MountainSteel AviationOtherPlease type dealer/broker's name* Did you consider purchasing a new Cirrus?*NoYesWhat did you base your decision on?*Why did you choose a Cirrus?*Insurance Policy/Proof of Insurance*UploadWill provide policy at another timeHave not acquired an insurance policy yetInsurance Policy/Proof of Insurance Upload*Max. file size: 50 MB. Where would you like to receive training?* City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What airport would you like to receive training?* 3 to 4 characters required Recognized ICAO code e.g. 3M0, KTYSFor this training, do you have a preferred Cirrus authorized training provider (CSIP or CTC)?*NoYesName of authorized Cirrus training provider (CSIP or CTC)* You only need to fill out this field if you have a preferred CSIP or CTCComments, concerns, or requests…Do you have a primary aircraft maintenance provider?*NoYesSelect and provide name*Cirrus Authorized Service CenterOtherMaintenance Provider Name* Optional Services Factory Instruction Fly with one of our renowned Cirrus Factory Flight Instructors, in Knoxville, TN, your home base, or anywhere in between. Our Factory Instructors have thousands of collective hours flight instructing in Cirrus aircraft and are experts in ensuring you get off to a great start in your new Cirrus! *Available only to aircraft installed with Cirrus Perspective and Cirrus Perspective+ avionics.*Additional Fees will apply. I'm interested in learning more about Factory Instruction. No Yes Factory Maintenance Have the Cirrus Factory take care of all your maintenance needs. Our specialized technicians are ready to provide a long list of services that will give you peace of mind. Find the best quality and world-class service at one of our two Factory Service Centers located in Knoxville, TN, and McKinney, TX. *Additional Fees will apply. I'm interested in learning more about Factory Maintenance. No Yes Cirrus Insurance Let us help make sense of the often-complex aspects of owning, operating, and training for your Cirrus aircraft. Leverage our experience for your insurance needs. Let our knowledgeable professionals at CIRRUS INSURANCE™ discuss rate information that is both current and competitive. Have you selected an insurance provider for this aircraft?*NoYesSelect and provide name*Cirrus Insurance Partner (Wings Insurance)OtherInsurance Provider Name* Our insurance partner, Wings Insurance, specializes in coverage for Cirrus aircraft & pilots and offers competitive rates. Would you like a representative from Wings Insurance to contact you with more information?*YesNoPlease enter your initials* By selecting “Yes” and entering your initials, you agree to allow Cirrus Aircraft to share your contact information with our insurance partner, Wings Insurance. Δ