Parachuting Center adult registration forms (photocopied set, duplicate)
Title revised to match the document’s own text.
Original title: Elsinore Parachuting Center adult registration forms (photocopied set, duplicate)
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Id: Cooper-Part-17:307-314
Subject: Cooper Files: Cooper-Part-17:307-314 Document: Parachuting Center adult registration forms (photocopied set, duplicate) Id: Cooper-Part-17:307-314 Page: https://cooper.theunsolved.net/documents/Cooper-Part-17%3A307-314 What is wrong (title, date, type, which pages belong together, copies)? What does the scan show?
A person reads every report. Corrections are made by hand, to the data — titles, dates, names, which pages belong together — never to the scans, and they can take a while to appear.
FBI 164-81, Vault Part 17 pp. 307–314 (DB Cooper-5137–5144), Form — cooper.theunsolved.net/documents/Cooper-Part-17%3A307-314
PARACHUTING CENTER ADULT REGISTRATION FORM
Permanent Address: [redacted] City: [redacted] se[ALIF]: [redacted] Zip Code: [redacted] Ph: [redacted] Weight: [redacted] Height: [redacted] Occupation: [redacted] Date of Birth: [redacted] Present Address: [redacted] City: [redacted] State / Zip Code: [redacted] Phone: [redacted] U S A
(Check Only One Please) High School: Attending B-I Not Complete Graduated
College: Please give name of: Attending Attended Graduated
Other
How did you learn of the center? (Check Only One Please) [ ] "A Sport Is Born" Movie [ ] Magazine Article [ ] Sports Show (Which) ___ [ ] Yellow Pages Ad [ ] World Championship 1962 [ ] Friend (Name) ___ [ ] Word of Mouth [ ] Lecture [ ] Other ___
HOW DID YOU TRAVEL TO CENTER? [ ] Plane [illegible] Car [ ] Bus [ ] Other ___
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Cardiac or pulmonary condition or disease 5.) Nervous disorder 2.) High or low blood pressure 6.) Diabetes 3.) Fainting spells or convulsions 7.) Kidney or related diseases 4.) Hard of hearing
Signature: [redacted] Date: [illegible]
IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE -- TURN FORM OVER -- READ AND COMPLETE OTHER SIDE [illegible fine print about insurance]
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PARACHUTING CENTER ADULT REGISTRATION FORM
Permanent Address: [redacted] City: [redacted] State: [redacted] Zip Code: [redacted] Ph: [redacted] Height: [redacted] Weight: [redacted] Occupation: [redacted] Date of Birth: [redacted] Sex: [redacted] Present Address: [redacted] City: [redacted] State / Zip Code: [redacted] Phone: [redacted] U S A
(Check Only One Please) High School: Attending B-I Not Complete Graduated
College: Please give name of: Attending Attended Graduated
Other
How did you learn of the center? (Check Only One Please) [ ] "A Sport Is Born" Movie [ ] Magazine Article [ ] Sports Show (Which) ___ [ ] Yellow Pages Ad [ ] World Championship 1962 [ ] Friend (Name) ___ [ ] Word of Mouth [ ] Lecture [ ] Other ___
HOW DID YOU TRAVEL TO CENTER? [ ] Plane [ ] Car [ ] Bus [ ] Other ___
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Cardiac or pulmonary condition or disease 5.) Nervous disorder 2.) High or low blood pressure 6.) Diabetes 3.) Fainting spells or convulsions 7.) Kidney or related diseases [illegible number] 4.) Hard of hearing
Signature: [redacted] Date: [illegible]
IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE -- TURN FORM OVER -- READ AND COMPLETE OTHER SIDE [illegible fine print about insurance]
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DB Cooper-5137
ADULT REGISTRATION FORM
[b6/b7C redactions throughout personal fields]
Date of Birth: [redacted] Age: [redacted] Weight: [redacted] Height: [redacted] Sex: [redacted] Occupation: [redacted] Address: [redacted]
(Check Only One Please) High School: Attending Did Not Complete Graduated
College; if so, give name of: Attending Attended Graduated
Other: [illegible]
How did you learn of this center? (Check Only One Please) "A Sport is Born" Movie Magazine Article Sports Show (Which) Yellow Pages Ad World Championship 1962 Friend (Name): [illegible] Word of Mouth Lecture Other: [illegible]
HOW DID YOU TRAVEL TO CENTER? [illegible] Bus Other
MEDICAL STATEMENT FOR PARACHUTE TRAINING AND JUMPING
[illegible partial text] ...any physical infirmity or chronic ail- ...have corrective lenses, and that I have
[illegible] ...made if [illegible] [illegible] ...Federal #[illegible]
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PARACHUTING CENTER ADULT REGISTRATION FORM
Permanent Address: [redacted] City: [redacted] State: [redacted] Phone: [redacted] Occupation: [redacted] Date of Birth: [redacted] Present Address: [redacted] City: [redacted] State/City/St: [redacted] Zip Code: [redacted] Phone: [redacted]
(Check Only One Please) High School: Attending Did Not Complete Graduated
College; Please give name of: Attending Attended Graduated
Other
How did you learn of this center? (Check Only One Please) "A Sport is Born" Movie Magazine Article Sports Show (Which) Yellow Pages Ad World Championship [guess: 1962] Friend (Name): [marked with X] Word of Mouth Lecture Other
HOW DID YOU TRAVEL TO CENTER? Plane Car Bus Other
USPA
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Cardiac or pulmonary condition or disease 5.) Nervous disorder 2.) Fainting or low blood pressure 6.) Diabetes 3.) Epileptic spells or convulsions 7.) Kidney or related diseases 4.) Hard of hearing
[Signature line - redacted]
Date 8/16/71
NOTICE — AFTER READING, NOTING AND DATING THIS SIDE — TURN FORM OVER — READ AND COMPLETE [illegible]
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DB Cooper-5138
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b6 b7C
[FOIA exemption markers: b6, b7C]
ADULT [guess: IDENTIFICATION] FORM
Check Only One Please [illegible] Date [illegible] [redacted fields]
[illegible] CAFE [illegible]
[redacted personal information blocks]
How did you learn of this [illegible]: (Check Only One) [checkbox] [illegible] of [illegible] [checkbox] [illegible] Article [checkbox] [guess: Magazine Article] [checkbox] [illegible] [checkbox] [illegible] [checkbox] [illegible] [checkbox] Other [illegible]
[illegible] only [illegible] and individually or otherwise do- [illegible] 4, and [illegible] $ [illegible]
[redacted block]
How did you learn of this [illegible]: (Check Only One) [illegible] [checkbox] "A Sport Is Born" [guess: Article] [checkbox] Magazine Article [checkbox] [guess: Newspaper Show schedule] [checkbox] Review/Report/Ad [checkbox] World Chart/Mailing List [checkbox] Friend (verbal) [illegible] [checkbox] Word of Mouth [checkbox] Other [illegible]
HOW DID YOU TRAVEL TO CONTACT? [checkbox] Phone [checkbox] M Car [checkbox] Bus [checkbox] Other [illegible]
---
[FOIA exemption markers: b6, b7C]
PREVIOUSLY CONTRIBUTED CONTACT
ADULT REGISTRATION FORM
Check Only One Please [illegible] [illegible] [checkbox] [illegible] [checkbox] [guess: Printed] [illegible] [checkbox] [illegible] [checkbox] [illegible]
[guess: Country] Club or give name of: [illegible] A[illegible] [checkbox] [illegible] [checkbox] [guess: Enclosed]
Other [illegible] [illegible]
[redacted personal information blocks]
[illegible] [illegible]
How did you learn of this [illegible]: (Check Only One) [illegible] [checkbox] "A Sport Is Born" [guess: Article] [checkbox] Magazine Article [checkbox] [guess: Newspaper Show schedule] [checkbox] Review/Report/Ad [checkbox] World Chart/Mailing List [checkbox] Friend (verbal) [illegible] [checkbox] Word of Mouth [checkbox] Other [illegible]
HOW DID YOU TRAVEL TO CONTACT? [checkbox] Phone [checkbox] M Car [checkbox] Bus [checkbox] Other [illegible]
INADEQUATE PROCESSING TRAINING AND SORTING
[illegible] are asked to [illegible] not under treatment for any physical information or chronic ail- ments [illegible] have normal vision or have corrective lenses, and that I have [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible]
4.) Nervous disorder 5.) [illegible] 6.) Diabetes 7.) Kidney or related diseases
Date: 3-1-71
[illegible] TURNS THIS SIDE -- TURNS [guess: THIS] OVER -- READ AND COMPLETE ON THIS SIDE
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DB Cooper-5139
PARACHUTING CENTER ADULT REGISTRATION FORM
Last Name: [blank] First: [blank] 1 Per[sonal] info: [partially illegible] Cal S[ex]: [blank] [blank] Age: [blank] Address: [blank]
Categor[y]: [blank] Date of birth: [blank] Alternate: [blank] Date of birth: [blank] Present Address: [blank]
City: State: a [or] Calif[ornia]
Pr[ior] [jump experience]: [blank]
How did you learn of the center? [ ] Only One Please [ ] A Friend or [Guest] Movie [ ] Newspaper Article [ ] Yellow [Pages] [ ] Yellow Pages Ad [ ] World Championship 1962 [ ] Friends Neighbor [ ] Word of Mouth [ ] Lecture [ ] Other
HOW DID YOU TRAVEL TO CENTER? [Phone] [or] [Car] [blank] Other
Date: [partially visible, possibly 4/7/ ]
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MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I here[by] certify that I am [aware of the] [risks] and am not under treatment for any physical infirmity or chronic ail- ments, or infirm[ity] of any nature, and that I have normal vision or have corrective lenses, and that I have [never] been treated for any of the following:
1.) Carbuncle or pulmonary condition or disease 2.) Night or low blood pressure 3.) Fainting spells or convulsions 4.) Period of hearing [loss] 5.) Nervous disorder 6.) Diabetes 7.) Kidney or related diseases
Date: [partially visible]
[illegible line] -- TURN FORM OVER -- READ AND COMPLETE O[THER SIDE]
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PARACHUTING CENTER ADULT REGISTRATION FORM
Last Name: [blank] [blank] Cal [blank fields]
Date of [birth]: [blank] Date of birth: [blank]
City: [blank] [blank]
How did you learn of the center? [ ] Only One P[lease] [ ] [blank] O[nly] One P. A [Friend] & [Guest] Mo[vie] N[ewspaper] Article [ ] Yellow Pages Ad [ ] World Champ[ionship] [ ] Friends Neighb[or] [ ] Word of Mouth [ ] [L]ecture [ ] Other
HOW DID YOU TRAVEL TO CENTER? [ ] Phone [ ] Car [ ] Bus [ ] Other
College: [blank] [or other]: [blank] Alt[ernate]: [blank] Approved: [blank] [Qual]ified: [blank]
Group: [blank]
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MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I here[by] certify that I am [aware of] and am not under treatment for any physical infirmity or chronic ail- ments, or infirm[ity] of any nature, and that I have normal vision or have corrective lenses, and that I have [never] been treated for any of the following:
1.) Carbuncle or pulmonary condition or disease 2.) [blank] or low blood pressure 3.) Fainting [spells] or convulsions 4.) Period of hearing [loss] 5.) Nervous disorder 6.1 Diabetes 7.) Kidney or related diseases
Date: [partially visible]
[illegible] -- TURN FORM OVER -- READ AND COMPLETE O[THER SIDE] [text partially illegible at bottom]
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b6 b7C
---
DB Cooper-5140
PARACHUTING CENTER
ADULT RE[GIST]RATION FO[RM]
Personal Address City: [illegible] State: [Ca?] Zip Code: [illegible] Age: [illegible] Wt: [pt] Height: [illegible] Occupation: [illegible] Date of Birth: [illegible] Sex: [illegible] Present Address: [illegible] City: [illegible] State: [illegible] Phone: [illegible]
Check Only One Please: High School: ( ) Attending ( ) Did Not Complete ( ) Graduated
College, Please give name of: ( ) Attending ( ) Attended ( ) Graduated
Other: [illegible]
How did you learn about us: (Check Only) ( ) "A Sport is Bo[rn]" ( ) Magazine Arti[cle] ( ) Sports Show (Wh[ere]) ( ) Yellow Pages A[d] ( ) World Champi[ons] ( ) Friend (Name) [illegible] ( ) Word of Mouth ( ) Lecture ( ) Other
HOW DID YOU TRAVEL TO CENTER? ( ) Plane ( ) Car ( ) Bus ( ) Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have no fear or hate of the following:
1. Cardiovascular problems 5a. Nervous disorder 2. Mental or similar problems 6a. Diabetes 3. Fainting or ear conditions 7a. Kidney or related diseases 4. None of the above
[Signature area]
TURN FORM OVER - READ AND COMPLETE
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PARACHUTING CENTER
ADULT REGISTRATION FORM
[Personal information fields - same layout as top form] City: [illegible] State: [Ca?] Zip Code: [illegible] Age: [illegible] Wt: [pt] Height: [illegible] Occupation: [illegible] Date of Birth: [illegible] Sex: [illegible] Present Address: [illegible] City: [illegible] State: [illegible] Phone: [illegible]
Check Only One Please: High School: ( ) Attending ( ) Did Not Complete ( ) Graduated
College, Please give name of: ( ) Attending ( ) Attended ( ) Graduated
Other: [illegible]
How did you learn about us: (Check Only One) ( ) "A Sport is Born" / ( ) Magazine Article ( ) Sports Show (Whi[te]) ( ) Yellow Pages Ad ( ) World Champions. ( ) Friend (Name) [illegible] ( ) Word of Mouth ( ) Lecture ( ) Other
HOW DID YOU TRAVEL TO CENTER? ( ) Plane ( ) Car ( ) Bus ( ) Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have no fear or hate of the following:
1. Card[iovascu]lar [or pulmonary] condition 2. M[ent]al or similar pres[sure] 3. Faint[ing] or ear cond[ition] or a 4. None of the a[bove]
[Signature area]
IMPORTANT: AFTER READING, SIGNING AND DATING THIS SIDE TURN FORM OVER READ AND COMPLETE
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DB Cooper-5141
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b6 b7C
ADULT REGISTRATION FORM
Last Name First Name Middle Initial Permanent Address State CALIF Zip Code Age Weight Height Occupation Date of Birth Sex [illegible] Present Address [illegible] City State Zip Code Phone
Check Only One Please: How did you learn of the center? High School "A Sport Is Born" Movie Attending Magazine Article Did Not Complete Sports Show (Which) Graduated Yellow Pages Ad World Championship 1962 College, Please give name of Friend (Name) Attending [illegible] Word of Mouth Graduated Lecture Other Other
HOW DID YOU TRAVEL TO CENTER? Auto Car Bus Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby state that I am not aware of any condition that would ever prevent me from [guess: undergoing] any physical infirmity or chronic ail- ments, or injury of any nature, and that I have normal vision or that I have corrective lenses, and that I have never been refused to [guess: enter] any of the following:
1. Cardiac or pulmonary condition or trouble 5. Nervous disorder 2. High or low blood pressure 6. Diabetes 3. Fainting spells or nervous fits 7. Kidney or related diseases 4. Hernia of [illegible]
Signature Date
IMPORTANT — AFTER READING, SIGNING AND DATING THIS SIDE — TURN FORM OVER — READ AND COMPLETE OTHER SIDE
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PARACHUTING CENTER ADULT REGISTRATION FORM
Last Name First Name Middle Initial Permanent Address State [illegible] Zip Code City [illegible] Age Weight Height Occupation Date of Birth Sex Present Address City State Zip Code Phone U.S.P.A.
Check Only One Please: How did you learn of the center? High School "A Sport Is Born" Movie Attending Magazine Article Did Not Complete Sports Show (Which) Graduated Yellow Pages Ad World Championship 1962 College, Please give name of Friend (Name) Attending [illegible] Word of Mouth Graduated Lecture Other Other
HOW DID YOU TRAVEL TO CENTER? Auto Car Bus Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby state that I am not aware of any condition that would ever prevent me from [guess: undergoing] any physical infirmity or chronic ail- ments, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been refused [guess: for] any of the following:
1. Cardiac or pulmonary condition or trouble 5. Nervous disorder 2. High or low blood pressure 6. Diabetes 3. Fainting spells or nervous fits 7. Kidney or related diseases 4. Hernia of [illegible]
Signature Date
IMPORTANT — AFTER READING, SIGNING AND DATING THIS SIDE — TURN FORM OVER — READ AND COMPLETE OTHER SIDE
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DB Cooper-5142
ADULT REGISTRATION FORM
Check Only One Please High School Attending A Sport Is Born Movie Got Into Parachute Co-located
College, Please give name of: Attending Attended Graduated
Other
Personal information fields: C/Y ___ N.Y. Zip Code Phone ___ Age ___ Weight ___ Height ___ Occupation ___ Date of Birth ___ Present Address ___ City ___ State ___ Zip Code Phone ___
How did you learn of the center? (Check Only One Please) [ ] "A Sport Is Born" Movie [ ] Magazine Article [ ] Sports Show (Which) [ ] Yellow Pages Ad [ ] World Championship 1962 [ ] Friend (Named) [ ] Word of Mouth [ ] Lecture [ ] Other
HOW DID YOU TRAVEL TO CENTER? : Private : Car : Bus : Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not aware of nor am I now under treatment for any physical infirmity or chronic ail- ment, or infirmity of any nature, and I [guess: also] have normal vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Cardiac or pulmonary condition or disease 5.) Nervous disorder 2.) High or low blood pressure 6.) Diabetes 3.) Fainting spells or convulsions 7.) Kidney or related diseases 4.) [guess: Loss] of hearing
Date 4 / [illegible] / [illegible]
TURN FORM OVER - READ AND COMPLETE OTHER SIDE
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PARACHUTING CENTER ADULT REGISTRATION FORM
[Identical form structure to section 1]
Check Only One Please High School Attending Got Not Complete Graduated
How did you learn of the center? (Check Only One Please) [ ] "A Sport Is Born" Movie [ ] Magazine Article [ ] Sports Show (Which) [ ] Yellow Pages Ad [ ] World Championship 1962 [ ] Friend (Named) [ ] Word of Mouth [ ] Lecture [ ] Other
HOW DID YOU TRAVEL TO CENTER? : Car : Bus : Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not aware of nor am I now under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and I [guess: also] have normal vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Cardiac or pulmonary condition or disease 5.) Nervous disorder 2.) High or low blood pressure 6.) Diabetes 3.) Fainting spells or convulsions 7.) Kidney or related diseases 4.) [guess: Loss] of hearing
Signature ___
IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE -- TURN FORM OVER -- READ AND COMPLETE OTHER SIDE
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b6 b7C
DB Cooper-5143
b6 b7C
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ADULT REGISTRATION FORM
Permanent Address _______________ [redacted] State [guess: Cal] Zip Code ___ Phone ________ Age ___ Weight 150 Height 5' [illegible] Occupation _______________ Date of Birth ___________ Sex M Present Address . [guess: Same as above] [illegible] City ________ State ___ Zip Code ___ Phone ________ S P A
(Check Only One Please) High School: How did you learn of the center? [ ] Attending (Check Only One Please) [ ] Did Not Complete [ ] "A Sport is Born" Movie [✓] Graduated [ ] Magazine Article [ ] Sports Show (Which) College: Please give name of: [ ] Yellow Pages Ad [ ] Attending [✓] World Champion [illegible] [ ] Attended [✓] Friend (Name) [redacted] [ ] Graduated [ ] Word of Mouth [ ] Lecture Other ___ Other ___
HOW DID YOU TRAVEL TO CENTER? [ ] Plane X Car [ ] Bus [ ] Other
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MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
"I hereby certify that I am not [guess: being] and am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have [guess: normal] vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Cardiac or pulmonary condition or disease 5.) Nervous disorder 2.) High or low blood pressure 6.) Seizures 3.) Fainting spells or convulsions 7.) Kidney or related diseases 4.) None of [guess: the above]
Signature _______________ [signature present] [guess: 1/30/71]
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IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE - TURN FORM OVER -- READ AND COMPLETE OTHER SIDE
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DB Cooper-5144