Part 17, page 465

Transcript

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

FOR USPA USE ONLY: USPA No.___ Postmark Date___ Amount___ (Ck., MO., Cash)

Name: D. B. COOPER (Please Print or Type) Mail Address: c/o YMCA. CANADA TORONTO City, State and ZIP Code___ USPA No. -- Phone -- Age___ Sex: YES [illegible]

A. Application: I hereby apply for membership in the United States Parachute Association as indicated below. (Please Note: Membership includes annual license validation.) CHECK ONE: ☐ New Membership — $15.00 ☐ Current Member Renewal — $12.00 ☐ Delinquent Member Renewal — $15.00 ☐ Family Membership Plan: Two members of an immediate family may join USPA at a $2.00 reduction in the total cost of two regular memberships provided they join at the same time and reside at the same address. ☒ Lifetime Membership: $200.00. Includes all regular membership benefits for life. Note: Membership, PL/PD Insurance, PARACHUTIST magazine subscription and other membership benefits expire on the last day of the twelfth month following the month in which the membership is issued. Membership dues are non-refundable. Please sign and complete all applicable information on reverse side.

MEMBERSHIP APPLICATION UNITED STATES PARACHUTE ASSOCIATION A Division of the National Aeronautic Association — P. O. Box 109, Monterey, California 93940

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[Upside-down bleed-through text from reverse side of form, partially legible:] MEMBERSHIP SECRETARY N. S. [guess: P.] A. P. O. BOX 109 [guess: MONTEREY, CALIFORNIA] [illegible additional lines]

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-b6 b7C

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DB Cooper-5299