Part 17, page 307

Transcript

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

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