Pre-Determined Landing Zone Application

Agency Name

Landing Zone Name

City

State

Illinois
Wisconsin

County

Major Cross Streets/Intersections

Dispatch Phone Number

Ground Contact Frequency

Lat/Long (in degrees, minutes, seconds)

Landing Zone (i.e. physical description)

Is Landing Zone

Paved
Unpaved

Hazards/Obstructions

Remarks

Name of Person Submitting this PDLZ Form

Date (DD/MM/YYYY)

Flight For Life