ExxonMobil Premier Spirit Pilot Pre-Enrollment

2008 PREMIERSPIRIT PROGRAM

Thank you for enrolling in the 2008 PremierSpirit program. This enrollment is for pilots only.

^*Denotes a required field.

^*License Number:

^*Create a 4-digit ID number:

SECURITY NOTE: Your PremierSpirit ID # will be composed of the last 4 digits of your pilot license number and the 4 digit number you create.

Tail #:

Pilots + Card Number:

^*First Name:

^*Last Name:

Company:

^*Address (No PO Boxes):

Suite/Apt Number:

^*City:

^*State/Province:

^*Zip/Postal Code:

(Required for US or Canadian Addresses)

^*Country:

^*Is this a residence:

-Y -N

^*Phone Number:

^*Email Address:

^*Military Pilot:

-Y -N

I have participated in previous PremierSpirit Programs:

-Y -N

Please rank the following gift choices (1 = highest; 4 = lowest):

Carefully make your ranking selections - These cannot be changed!