E-mail Notification Request Form

If you would like to receive notification complete as much of the information below as you have the necessary information below. This information will be used to attempt to send you an e-mail reminder of scheduled repack and maintenance. Expect your e-mail reminder notice about 15 days before the last day in your repack cycle (upon request we will send your notices via snail-mail). Your reminder will also contain information about your gear such as Manufacture, Model, Serial Numbers, of major components as well as information about required scheduled maintenance such as AAD service, battery replacements, etc.

Please provide the following contact information (* Indicated Minimum Required Field).

* Name

* Date Reserve Was Last Packed
-- mm/dd/yy

Notification Method

* E-mail

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

URL

Comments

In the following fields you can provide information about other equipment. We will keep the information on file and should you need it (say your gear is stolen) we will have a record of it.

Also, if the gear listed has a service life, maintenance or service intervals we will remind you of those too!

Harness and Container - Mfg.

Harness and Container - Model

Harness and Container - Date of Mfg. -- mm/dd/yy

Harness and Container - Serial Number

Reserve Canopy - Mfg.

Reserve Canopy - Model

Reserve Canopy - Date of Mfg. -- mm/dd/yy

Reserve Canopy - Serial Number

AAD - Mfg.

AAD - Model

AAD - Date of Mfg. -- mm/dd/yy

AAD - Last Battery Change -- mm/dd/yy

AAD - Serial Number

Main Canopy - Mfg.

Main Canopy - Model

Main Canopy - Date of Mfg. -- mm/dd/yy

Main Canopy - Serial Number

WARNING – Parachute jumping (skydiving) is a potentially dangerous activity that can result in injury or death.
Each individual participant, regardless of experience, has final responsibility for his or her own safety.
Last updated: May 03, 2007 - Copyright ©2003 All rights reserved. You are visitor Hit Counter since 19-Dec-02.