Part 17, page 312

Transcript

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

ADULT REGISTRATION FORM

Last Name First Name Middle Initial Permanent Address State CALIF Zip Code Age Weight Height Occupation Date of Birth Sex [illegible] Present Address [illegible] City State Zip Code Phone

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

HOW DID YOU TRAVEL TO CENTER? Auto Car Bus Other

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby state that I am not aware of any condition that would ever prevent me from [guess: undergoing] any physical infirmity or chronic ail- ments, or injury of any nature, and that I have normal vision or that I have corrective lenses, and that I have never been refused to [guess: enter] any of the following:

1. Cardiac or pulmonary condition or trouble 5. Nervous disorder 2. High or low blood pressure 6. Diabetes 3. Fainting spells or nervous fits 7. Kidney or related diseases 4. Hernia of [illegible]

Signature Date

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

---

PARACHUTING CENTER ADULT REGISTRATION FORM

Last Name First Name Middle Initial Permanent Address State [illegible] Zip Code City [illegible] Age Weight Height Occupation Date of Birth Sex Present Address City State Zip Code Phone U.S.P.A.

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

HOW DID YOU TRAVEL TO CENTER? Auto Car Bus Other

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby state that I am not aware of any condition that would ever prevent me from [guess: undergoing] any physical infirmity or chronic ail- ments, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been refused [guess: for] any of the following:

1. Cardiac or pulmonary condition or trouble 5. Nervous disorder 2. High or low blood pressure 6. Diabetes 3. Fainting spells or nervous fits 7. Kidney or related diseases 4. Hernia of [illegible]

Signature Date

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

---

DB Cooper-5142