Welcome to 28th Annual Arkansas Hot Air Balloon State Championship Pilot Registration Form ***We will only accept the first 20 pilots registered!!***                                                                                 
September 8, 9 & 10, 2023
Being Held at the Anstaff Soccer Complex
202 Old Stonewall Road, Harrison, AR 72601
Registration Deadline is Noon, September 1, 2023
Contact: Renée Swanson
Explore Harrison
200 W. Stephenson
Harrison, AR 72601
870-741-1789
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Pilot's Name: *
Address, City, State and Zip: *
Phone Number: *
Email Address: *
Pilot Certificate Number: *
Balloon Number: *
Balloon Name: *
Balloon Description: *
Date of Manufacture: *
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/
DD
/
YYYY
Private or Commercial: *
Total PIC Hours: *
Number of PIC Hours in the Last 12 Months: *
Last Biennial: *
MM
/
DD
/
YYYY
Occupancy of Basket: Pilot + *
Weight Limit: *
Insurance Carrier: *
Insurance Policy Number: *
Insurance Period: *
Required Insurance Minimums of $100,000 minimum per passenger, $300,000 minimum, combined single limit B.I./P.D. *
Required
How many crew members do we need to secure for you? *
Will You Be Tethering? *
Pilot Shirt Size: *
Complimentary Pilot Hotel Room: *
$50 Registration fee will be added to your show-up money if paid by debit or credit card. If paying registration fee by check, your check will be returned to you along with your show-up money. 

Your registration fee will be returned along with an additional $250 on Sunday, September 10, 2023 *
I certify that the hot air balloon listed above has a standard airworthiness certificate and that it has been inspected in accordance with FAA requirements within the last year. I also certify that I hold a pilot's license for this event, have had a current biennial check ride and carry the required insurance as stated above. *
Required
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