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2. Name*
3. Email Address*
5. Address / Area of Flight Operations*
7. Mailing Address*
9. City*
10. State*
11. Zip Code*
13. Home Phone Number*
14. Cell Phone Number*
16. Date / Time of Flight*
    Date / Time of Flight

    Date / Time of Flight
17. Duration of Flight*
19. UAS (Drone) Make*
20. Model Number*
22. FAA Assigned Registration Number*
24. Do you have insurance?

    1. Yes
    2. No
25. Name of Insurance Company*
27. Confirm you have reviewed "Know Before You Fly".*

    1. Yes
    2. No
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field