Part 64, page 397

Transcript

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

ADULT [redacted] REGISTRATION FORM

Check Only One Please) High School [redacted] Attending Did Not Complete Graduated

College, if one give name of: Attending Attended Graduated

Other:

HOW DID YOU TRAVEL TO CENTER? [redacted] Bus [checkbox] Other

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

Other:

b6 b7C

[redacted personal information fields including name, address, city, state, zip code, phone]

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify that I am not a victim of 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 under [medical] for any of the following:

1.) Cardiac or pulmonary condition or disease 2.) [illegible] or [illegible] paralysis 3.) Fainting spells or convulsions 4.) [Loss] of hearing

5.) Nervous disorder 6.) Diabetes 7.) Kidney or related diseases

Date: 9/14/71

---

PARACHUTING CENTER

ADULT REGISTRATION FORM

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

College: Please give name of: Attending X Attended Graduated

Other:

HOW DID YOU TRAVEL TO CENTER? [checkbox] Plane X Car [checkbox] Bus [checkbox] Other

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

Other:

b6 b7C

[redacted personal information]

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify that I am not a victim 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 under [medical] for any of the following:

1.) Cardiac or pulmonary condition or disease 2.) [illegible] or [illegible] paralysis 3.) Fainting spells or convulsions 4.) [Loss] of hearing

5.) Nervous disorder 6.) Diabetes 7.) Kidney or related diseases

Date: 9/14/71

I HAVE READ A [illegible] PERTAINING AND JUMPING THIS SIDE -- TURN FORM OVER -- READ AND SIGN OTHER SIDE [illegible additional instruction text]

---

DB Cooper-26847