Part 17, page 311

Transcript

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

PARACHUTING CENTER

ADULT RE[GIST]RATION FO[RM]

Personal Address City: [illegible] State: [Ca?] Zip Code: [illegible] Age: [illegible] Wt: [pt] Height: [illegible] Occupation: [illegible] Date of Birth: [illegible] Sex: [illegible] Present Address: [illegible] City: [illegible] State: [illegible] Phone: [illegible]

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

College, Please give name of: ( ) Attending ( ) Attended ( ) Graduated

Other: [illegible]

How did you learn about us: (Check Only) ( ) "A Sport is Bo[rn]" ( ) Magazine Arti[cle] ( ) Sports Show (Wh[ere]) ( ) Yellow Pages A[d] ( ) World Champi[ons] ( ) Friend (Name) [illegible] ( ) 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 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 no fear or hate of the following:

1. Cardiovascular problems 5a. Nervous disorder 2. Mental or similar problems 6a. Diabetes 3. Fainting or ear conditions 7a. Kidney or related diseases 4. None of the above

[Signature area]

TURN FORM OVER - READ AND COMPLETE

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PARACHUTING CENTER

ADULT REGISTRATION FORM

[Personal information fields - same layout as top form] City: [illegible] State: [Ca?] Zip Code: [illegible] Age: [illegible] Wt: [pt] Height: [illegible] Occupation: [illegible] Date of Birth: [illegible] Sex: [illegible] Present Address: [illegible] City: [illegible] State: [illegible] Phone: [illegible]

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

College, Please give name of: ( ) Attending ( ) Attended ( ) Graduated

Other: [illegible]

How did you learn about us: (Check Only One) ( ) "A Sport is Born" / ( ) Magazine Article ( ) Sports Show (Whi[te]) ( ) Yellow Pages Ad ( ) World Champions. ( ) Friend (Name) [illegible] ( ) 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 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 no fear or hate of the following:

1. Card[iovascu]lar [or pulmonary] condition 2. M[ent]al or similar pres[sure] 3. Faint[ing] or ear cond[ition] or a 4. None of the a[bove]

[Signature area]

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

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DB Cooper-5141

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