FLIGHT REVIEW PLAN AND CHECKLIST


       Name _________________________________________________________ 
       
       Date __________________________________________________________

       Grade of Certificate _____________ Certificate No. _____________

       Ratings and Limitations _____________________________________

       Class of Medical _____________  Date of Medical ______________

       Total Flight Time _________________ Time in Type _____________

       Aircraft to be Used:  Make and Model __________ N# ____________

       Location of Review ________________________________________

       I.  REVIEW OF FAR PART 91

           Ground Instruction Hours: ________

           Remarks: ________________________________________

       II. REVIEW OF MANEUVERS AND PROCEDURES (list in order of
           anticipated performance)

           A. _____________________________
           B. _____________________________
           C. _____________________________
           D. _____________________________
           E. _____________________________
           F. _____________________________
           G. _____________________________
           H. _____________________________
           I. _____________________________
           J. _____________________________
           K. _____________________________
           L. _____________________________
           M. _____________________________
           

            Flight Instruction Hours: ______________

            Remarks: _____________________________________________

            
      III. OVERALL COMPLETION OF REVIEW

            Remarks: ________________________________________

            Signature of CFI ______________________ Date ______________

            Certificate No. _______________ Expiration Date __________

            I have received a flight review which consisted of the
            ground instruction and flight maneuvers and procedures
            noted above.

            Signature of the Pilot __________________ Date __________