Part 17, page 308

Transcript

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

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