Your Information (optional)

Name

Your Organization/Company

Email

Cell Phone

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Other Phone

Event Information (required)

Event Date

Event Local Time

Were injuries involved?

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Event State/Province

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Customer/Contracting Agency

Aircraft Info

Category (required)

Type (Bell 206, UH-1, etc.)

Tail # (required)

Pilot Name

Other Aircraft Info

Event Narrative (required)

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Remedy or Corrective Action (required)

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