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Application for Registration of

Federal Airman Certificate

FAA Number / I am Exempt from Registration
(select exemption below)

Reason for Exemption

Currently Not Air Navigating in IL Fly Only for the Military
Fly Only for the Government Fly Only Interstate Commerce

Pilot Information

Last Name / First Name / MI / Sex
Street Address / City / State / Zip Code
-
County / Birth Date / Telephone No. (Optional)
() - / E-Mail Address (Optional)

Certificate Information

Type Certificate

ATP - Airline Transport Pilot COM - Commercial PVT - Private REC - Recreational
STU - Student SPR - Sport ULT - Ultralight NA - Not Applicable

Flight Instructor Ratings

Instrument Rotocraft Glider Airplane
Ultralight Balloon Multi-Engine Not Applicable

Engine Rating

SEL SES MEL MES
SELS MELS NA

Other Ratings

A - Interstate Commerce B - LTA Free Balloon C - Control Tower Operator D - Hot Air Balloon
E - Flight Engineer I - Instrument N - Flight Navigator O - Glider
X - Rotocraft/Helicopter Y - Rotocraft/Gyro Z - Government

AirMail – The electronic version of Illinois Aviation available to pilots

AirMail is the e-mail version of the Illinois Aviation newsletter. This is the only version that is available to pilots – Illinois Aviation will no longer be mailed.
There are three different ways you may sign up: 1) go to https://goo.gl/4QHZKE; 2) scan the following QR code; 3) or check the box below and we will make sure you are signed up.
I wish to receive AirMail
I hereby certify that I hold the above described FAA Airman Certificate and that the same is in full force and effect.
Signature / Date

Instructions

1. / Complete this application by providing pertinent information from your Federal Airman Certificate. Print or type all information. Illegible or incomplete applications may be returned.
2. / Effective January 1, 2017, a one-time pilot registration fee of $20.00 is required. A Certificate of Registration, with no expiration date, will be mailed to the registrant as soon as possible.
3. / Make remittance payable to the State Treasurer of Illinois. CASH WILL NOT BE ACCEPTED
4. / Submit check, draft, or currency exchange money order with application to the following address.
Illinois Department of Transportation
Division of Aeronautics
1 Langhorne Bond Drive / Capital Airport
Springfield, Illinois 62707-8415
(800) 554-0247
5. / Renewals may be completed online at https://ppr.dot.illinois.gov.
The Division of Aeronautics will not accept stamps and assumes no responsibility for the loss of currency sent through the mail.
Operation of an aircraft without proper registration of a Federal Airman Certificate is a Class A misdemeanor punishable by a fine not to exceed $1,000 and/or up to one year in jail. See 620ILCS 5/42 (1992) IL Compiled Statutes.

Printed 1/5/2017AER 1967 (Rev. 01/06/17)