Part 17, page 295

Transcript

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

ADULT REGISTRATION FORM

[Personal information fields - mostly blank] C___ | NY | __ High School: Pr_v_s | __ | __ | __ ___ "A Sport is Born" Movie Occupation: Magazine Article Date of Birth | DAY | MONTH | YEAR | / Sports Show (Which) Present Address Yellow Pages Ad City | State | Zip Code World Championship 19__ Phone __ Friend (Name) __ ___ Word of Mouth Lecture Other

Check Only One Please: How did you learn of the center? (Check Only One Please)

College, Please give name of: Attending Attended Graduated

Other

HOW DID YOU TRAVEL TO CENTER? __ [Train] __ Car __ Bus __ Other

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify that I am not under [guess: care] and not under treatment for any physical infirmity or chronic ail- ment, or infir[m]y 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.) Coronary or pulmonary condition or disease 5.) Nervous disorder 2.) High or low blood pressure 6.) Diabetes 3.) 7.) Kidney or related diseases 4.)

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

Per________ C___ | NY | __ | Zip Code Name | Age | We__nt__ | He_ght Occupation

Date of Birth | DAY | MONTH | YEAR Present Address City ______ | State | Zip Code

Phone __ __ __ /__ __ ___

Check Only One Please: How did you learn of the center? (Check Only One Please) High School: "A Sport is Born" Movie Attending Magazine Article Did Not Complete Sports Show (Which) Credentialed Yellow Pages Ad World Championship 1962 College, Please give name of: Friend (Name) Attending Word of Mouth Attended Lecture Graduated Other

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 under [guess: care] and not under treatment for any physical infirmity or chronic ail- ment, or infir[m]y 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. Coronary or pulmonary condition or disease 5. Nervous disorder 2. High or low blood pressure 6. [guess: Diabetes] 3. Forming spells or convulsions 7. Kidney or related diseases 4. None of above

Signature | Date __ / __ / __

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

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DB Cooper-5125