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2. Disclaimer
   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
4. Fee Information
   A $30 fee is required before your name will be placed on the T-hangar wait list(s). Please call 303-271-4850 to provide payment after submitting this form.
6. Todays Date*
   Todays Date
8. First Name*
9. Last Name*
11. Address*
13. City
14. State
15. Zip Code
16. Country
18. Phone Number*
19. Email Address
21. Category of Aircraft*

    1. I (Single) 39 feet by 28 feet and 6 inches with 140 inch doors
    2. II (Single) 41 feet by 31 feet and 6 inches with 154 inch doors
    3. III (Twin) 55 feet and 6 inches by 44 feet with 194 inch doors
23. Verification*

    I understand that my name will be placed on the waiting list in accordance with the date of receipt of this form. If there are any changes to this information, I will contact the airport as soon as possible.

    1. I agree to the above statement.
25. Do you currently own an aircraft?*

    1. Yes
    2. No
27. If no, when do you expect to get an aircraft?
29. Notes
    * Pursuant to C.R.S. § 24-72-203, information submitted on this form is subject to any public records request for said information.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field