Part 64, page 400

Transcript

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

PARACHUTING CENTER ADULT REGISTRATION FORM

[redacted] n [illegible] Check Only One: Please) How did you [learn]: Check Only [One]

High School _ Attending _ Did Not Complete _ Graduation

College, Please give name of: _ Attending _ [Finished] _ Graduated

Other:

HOW DID YOU TRAVEL TO CENTER? [illegible] Train, S-Car [illegible], Bus, [illegible] Other

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I [illegible] certify that I am not under a doctor's treatment for any physical infirmity or chronic ail- [ment] [illegible] that I have [not] had [illegible] normal vision or have corrective lenses, and that I have [illegible] my [illegible] knowledge:

1. [illegible] disorder 2. Diabetes 3. [Fainting] or [related] [diseases]

[Signature block - redacted]

DATE: [redacted] OVER [illegible] READ AND COMPLETE [illegible]

---

PARACHUTING CENTER ADULT REGISTRATION FORM

[redacted] Check Only One Please) How did you [learn]: (Check Only One)

High School: _ Attending _ Did Not Complete _ Graduation

College, please give name of: _ Attending _ Attended _ Graduated

Other:

How did you [learn]: Check Only One _ "A Sport is Born" _ Magazine Article _ Sports Show [illegible] _ Yellow Pages Ad _ World Champions _ Friend (Name) _ Word of Mouth _ Lecture _ Other

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

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify that I am not under a doctor's treatment for any physical infirmity or chronic ail- ment, or [member] of any [illegible] normal vision or have corrective lenses, and that I have [illegible] to [the best] of my [illegible] knowledge, [illegible] [illegible] that I have

1. Chronic or pronounced [illegible] condition 2. [heart] or [illegible] condition or [illegible] 3. [illegible] [significant] or [illegible] 4. [illegible] of [relevant] [illegible]

[Signature block - redacted]

DATE: [redacted] NOTATION -- AFTER READING, SIGN AND RETURN BACK. THIS [illegible] FORM OVER READ AND COMPLETE. [illegible]

---

DB Cooper-26850

---

b6 b7C