Part 64, page 396

Transcript

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

PARACHUTING CENTER

ADULT REGISTRATION FORM

(Check Only One Please)

High School: [illegible] Attending [illegible] Did Not Complete X Graduated

College: Please give name of: 1. Attending 2. Attended 3. Graduated

Other

How did you learn of the center? (Check Only One Please) [] "A Sport Is Born" Movie [] Magazine Article [] Sports Show (Which) ____ [] Yellow Pages Ad [] World Championship 1962 [] Friend (Name) ____ [] Word of Mouth [] Lecture Other ____

(CALIF[ornia] ____) Name: [illegible] Address: [illegible] Date of Birth: [illegible] Occupation: [illegible] City: [illegible] State: [illegible] Zip Code: [illegible] Phone: [illegible] Present Interests: [illegible]

HOW DID YOU TRAVEL TO CENTER? [] Phone [illegible] Car [illegible] Bus [] Other

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.) Corr[ect] or pulmonary condition or disease 5.) Nervous disorder 2.) Fainting or low blood pressure 6.) Diabetes 3.) [illegible] spells or convulsions 7.) Kidney or related diseases 4.) Kind of hearing

Signature: [illegible] Date: [illegible]

TURN FORM OVER -- READ AND COMPLETE OTHER SIDE

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PARACHUTING CENTER

ADULT REGISTRATION FORM

(Check Only One Please)

High School: [illegible] Attending [illegible] Did Not Complete [] Graduated

College: Please give name of: 1. Attending 2. Attended 3. Graduated

Other

How did you learn of the center? (Check Only One Please) [] "A Sport Is Born" Movie [] Magazine Article [] Sports Show (Which) ____ [] Yellow Pages Ad [] World Championship 1962 [] Friend (Name) ____ [] Word of Mouth [] Lecture Other ____

Name: [illegible] Angelet Address: [illegible] City: [illegible] State: [illegible] Zip Code: [illegible] Date of Birth: [illegible] Present Interests: [illegible] Phone: [illegible]

HOW DID YOU TRAVEL TO CENTER? [] Phone [] Car [] Bus [] Other

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.) [illegible] spells or convulsions 7.) Kidney or related diseases 4.) Kind of hearing

Signature: [illegible] Date: [illegible]

TURN FORM OVER -- READ AND COMPLETE OTHER SIDE [illegible] -- [illegible] READING AND EATING THIS SIDE -- TURN FORM OVER -- READ AND COMPLETE O[THER SIDE] [illegible text at bottom]

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DB Cooper-26846

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b6 b7C