Parachuting center adult registration form and medical statement
Report a problem
Email this to [email protected]
Id: Cooper-Part-70:098-098
Subject: Cooper Files: Cooper-Part-70:098-098 Document: Parachuting center adult registration form and medical statement Id: Cooper-Part-70:098-098 Page: https://cooper.theunsolved.net/documents/Cooper-Part-70%3A098-098 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 70 p. 98 (DB Cooper-29849), Form — cooper.theunsolved.net/documents/Cooper-Part-70%3A098-098
ADULT REGISTRATION FORM
[illegible] b. [illegible]
High School [illegible] [illegible] Date of Birth: [illegible] [illegible] Address
City [illegible] State [illegible]
How and you [guess: learn] of Check Only One Please A [guess: short] in a [guess: Movie] Magazine Article Sports Show [guess: WWII] Yellow Pages Ad World Championship 1962 Friend [Named] Word of Mouth [guess: Lecture] Other
HOW DID YOU TRAVEL TO CENTER?
Plane to [illegible] + Bus [illegible] Other
---
ADULT REGISTRATION FORM
[illegible fields]
Date of Birth [illegible] [illegible] Address
City [illegible] State [illegible]
Race [illegible]
HOW DID YOU TRAVEL TO CENTER?
Plane to [illegible] + Bus [illegible] Other
---
ADDITIONAL STATEMENT FOR UNDERGONE PARACHUTE TRAINING AND JUMPING
I [guess: hereby] certify that I [guess: have] not any [guess: current] or [guess: past] [guess: under] treatment for any physical infirmity or chronic ail- ments, or history of any [guess: surgery, that] I do not [guess: require] [guess: corrective] lenses, and that I have [illegible] [guess: no] [guess: defects] [illegible] for [guess: any] of the [guess: following]:
1.] Contacts or [guess: glasses] or [guess: prescription] [guess: lenses] or [guess: devices] 2.] 3.] 4.]
5.) Nervous disorder 6.) [guess: Diabetes] 7.) Kidney or related diseases
Date [illegible]
THIS FORM OVER - READ AND COMPLETE OTHER
---
PARACHUTING CENTER
ADULT REGISTRATION FORM
Check Only One Please
High School .1 Attending .? [guess: Did] Not Complete . Checked
[guess: College] [guess: or] [guess: other] [guess: name] of .1 Attending .2 Attended .3 [guess: Graduated]
[guess: Other]
How did you learn of this center? (Check Only One Please) [guess: A] "A Sport is Born" Movie Magazine Article Sports Show [guess: WWII] Yellow Pages Ad World Championship 1962 Friend [Named] Word of Mouth Lecture Other
HOW DID YOU TRAVEL TO CENTER? Car + Bus [illegible] Other
---
MEDICAL STATEMENT FOR UNDERGONE PARACHUTE TRAINING AND JUMPING
I [guess: hereby] certify that I am not [guess: and] have not [guess: ever] [guess: been] [guess: under] treatment for any physical [guess: infirmity] or chronic ail- ment, or [guess: any] [guess: of] [guess: any] [guess: nature] or [guess: that] I have [guess: corrective] lenses, and that I have
1.) [guess: Contacts] or [guess: glasses], [guess: or] [guess: prescription] [guess: lenses] 2.) [illegible] 3.) [guess: Fainting] or [guess: dizzy] or [guess: convulsions] 4.) [guess: Heart] or [guess: circulatory] [illegible]
5.) Nervous disorder 6.) [illegible] 7.) Kidney or related diseases
Date [illegible]
IMPORTANT - AFTER READING, SIGNING AND DATING THIS SIDE -- TURN FORM OVER -- READ AND COMPLETE OTHER SIDE
---
DB Cooper-29849
Serials: 29849