Part 55, page 107

Transcript

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

PARACHUT[ING] CENTER ADULT R[EGI]STRATION FOR[M]

Check Only One Please High School __ Attending __ Do Not Comp[lete]; [illegible] __ Graduated

College, Please give name of __ Attending __ Attended __ Graduation

How did you le[arn] (Check Only On[e]) __ "A Sport Is Bo[rn]" __ Magazine Art[icle] __ Sports Show W[alk] [illegible] Yellow Pages Ad __ World Champi[on] __ Friend (Name) __ Word of Mouth __ [L]ecture

Other __

HOW DID YOU TRAVEL TO CENTER? [illegible] Plane S-Car [illegible] Bus __ Other

MEDICAL STAT[EMENT] [FOR] UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify th[at I am] not [illegible] [and am] not under treatment for any physical infirmity or chronic ail- [ment] [illegible] or [illness] of any nature, and [that] I have normal [vision] or have corrective lenses, and that I have [illegible] [illegible] [illegible]

[Form fields for personal information - redacted with b6, b7C blocks] Name [REDACTED] Age [REDACTED] Date [REDACTED] Height Occupation [REDACTED] Date of Birth [REDACTED] Sex Present Address [REDACTED] City __ State Phone [REDACTED]

1) [illegible] education 2) [illegible] [illegible] 3) [illegible]

5) [illegible] disorders 6) Fractures 7) History of related diseases

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PARACHUTING CENTER ADULT REGISTRATION FORM

Check Only One Pleas[e] High School __ Attending __ Did Not Complete __ Graduated

College, Please give name of __ Attending __ Attended __ Graduat[ed]

How did you learn [about] (Check Only One) __ "A Sport Is Born" [?] __ Magazine Article __ Sports Show Walk __ Yellow Pages Ad __ World Champions __ Friend (Name) __ __ Word of Mouth __ Lecture

Other

HOW DID YOU TRAVEL TO CENTER? Plane __ Car __ [illegible] Other

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify th[at I] [am] [in good] [health] and am not under treatment for any [physical] infirmity or chronic ail- ment, or [illness] of any nature, and [that] I have normal [vision] or have [corrective] lenses, and that I have [illegible]

[Form fields - redacted with b6, b7C blocks] S [illegible] Date [REDACTED] Occupation [REDACTED]

1) Care of or [pulmonary] [illegible] or [illegible] 2) [illegible] or [illegible] [illegible] 3) [illegible] [for] [illegible] 4) [illegible] [illegible] [illegible] DAT[E] [REDACTED]

PATIENT — AFTER READING, SIGN AND DATE EATING THIS [HALF] [illegible] [illegible] [illegible]

RIGHT FORM OVER

READ AND COMPLY.

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DB Cooper-23250