Part 64, page 399

Transcript

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

PARACHUTING [CENTER] [illegible] FORM

ADULT REGISTRATION FORM

[Fields, mostly illegible:] Last Name . . . First . . . MI Date . . . [Ca] . . . Age . . . [illegible] Sex . . . [illegible] . . . City . . .

Have you been of the center? [illegible] Gray [Comp R.] A [illegible] [illegible] Mother [illegible] [illegible] [Julianne] [illegible] Show Within [illegible] Finger Ad b6 [illegible] Championship 1962 b7C [illegible] Fingers [illegible] Word of Mouth [illegible] Other

HOW DID YOU TRAVEL TO CENTER? Car . . . Bus . . . Other

MEDICAL STATEMENT: [I am a] [illegible] UNDERGOING PARACHUTE TRAINING AND JUMPING [I hereby] [certify] [that I] [am] [in] [good health] [and] [not] [under] [treatment] for any physical infirmity or chronic ail- [ment], or [illegible] of any [nature], and that I have normal vision or have corrective lenses, and that I have [no] [illegible] [for] [illegible] [illegible] [of] [this] [undertaking]:

[Conditions or additional] [illegible] [order] [or] [illegible]: 5. Nervous disorder 6. Diabetes 7. [Kidney] or related diseases [illegible] [of] [illegible]

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PARACHUTING CENTER

ADULT REGISTRATION FORM

[Fields, mostly illegible:] [illegible] . . . [illegible] [Ca] [illegible]

Have you [been] of [the center]? [illegible] [City] [Comp R.] A [illegible] [illegible] [illegible] [illegible] [illegible] Article [illegible] [Shows] [Show] [illegible] b6 [Yellow] Pages [Ad] b7C [illegible] [Comp] [onion] [Friends] Name- [Word] of Mouth [illegible] Other

HOW DID YOU TRAVEL TO CENTER? Car . . . Bus . . . Other

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING [I hereby] [certify] [that I am] [in] [good] [health] [and] [not] [under] [treatment] for any physical infirmity or chronic ail- [ment], or [illegible] of any [nature], and that I have normal vision or have corrective lenses, and that I have [no] [illegible] [for any] [of] [this] [undertaking]:

[Conditions or [illegible] [or] [illegible]: 5a. Nervous disorder 6. Diabetes 7. [Kidney] or related diseases

[illegible]

Date . . . [illegible]

[NOTE:] [illegible] [illegible] [illegible] [DATING] THIS SIDE -- TURN FORM OVER -- READ AND COMP[LETE]

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DB Cooper-26849