Part 17, page 293

Transcript

The scan is the source; the transcript is machine-generated from it.

PARACHUTING CENTER ADULT REGISTRATION FORM

Personal Address City _________ State _________ Zip Code _________ Age _________ Weight _________ Height _________ Occupation _________ Date of Birth Day _________ Month _________ Year _________ Present Address _________ City _________ State _________ Zip Code _________ Phone _________

(Check Only One Please) High School Attending Did Not Complete Graduated

College, Please give name of: Attending Attended Graduated Other _________

HOW DID YOU TRAVEL TO CENTER? Plane By-Car Bus Other

How did you learn (Check Only One) "A Sport Is Born" (?) Magazine Article Sports Show /What Yellow Pages Ad World Champion Friend (Name) _ Word of Mouth Lecture Other _________

b6 b7C

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 [illegible] and am not under [illegible] or have normal vision or have corrective lenses, and that I have never [illegible] a [illegible] of the following conditions:

1. Chronic or pulmonary condition, or similar disease 2. Bone or joint problems 3. Fainting spells or unconsciousness 4. [illegible] of heart [illegible] 5. Nervous disorder 6. Diabetes 7. Kidney or related diseases

PLEASE TURN OVER - READ AND COMPLETE

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PARACHUTING CENTER ADULT REGISTRATION FORM

Personal Address City _________ State _________ Zip Code _________ Age _________ Weight _________ Height _________ Occupation _________ Date of Birth Day _________ Month _________ Year _________ Present Address _________ City _________ State _________ Zip Code _________ Phone _________

(Check Only One Please) High School Attending Did Not Complete Graduated

College, Please give name of: Attending Attended Graduated Other _________

HOW DID YOU TRAVEL TO CENTER? Plane [illegible] Car Other

How did you learn (Check Only One) "A Sport Is Born" (?) Magazine Article Sports Show /What Yellow Pages Ad World Champions Friend (Name) _ Word of Mouth Lecture Other _________

b6 b7C

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify that I am not under treatment for any physical infirmity or chronic ail- [illegible] or have normal vision or have corrective lenses, and that I have [illegible]

1. Chronic or pulmonary condition, or similar disease 2. Bone or joint problems 3. Fainting spells or unconsciousness 4. [illegible] of [illegible]

PLEASE TURN OVER

IMPORTANT - AFTER READING, SIGNING AND DATING THIS SIDE TURN FORM OVER READ AND COMPLETE

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DB Cooper-5123