Student Registration Form

First Name *

Last Name *

Email *

Phone *

Your cell phone number is important in case we need to exchange messages before arriving or at the airpont.

Date of birth *

Gender *

Female

Male

Other

Your Gender needs to match the Gender on your official government ID

Name as it appears of your official ID (Drivers License, etc.) *

Your name needs to match with the ID you will be presenting at TSA Security Checkpoint

Are you bringing a guest with you? *

NO, it's just me coming

YES, I want to bring a guest

Please let us know whether you are coming by yourself or want to bring a support person with you.

PHOTOGRAPHY, VIDEO AND AUDIO RECORDING WILL OCCUR DURING CLASS. *

YES, I understand and consent that I (and my coach) may be photographed, video and audio recorded during the event.

I understand and consent that I (and my coach) may be photographed, video and audio recorded during the event.

Main Topics of Interest *

Takeoff and/or Turbulence

Flying over Water / Long Flights

Claustrophobia / Panic Attacks

Anticipatory Anxiety

I agree to terms & conditions provided by FearlessFlight®. I agree to receive text messages and updates from Capt Ron and FearlessFlight®.