Part 64, page 401

Transcript

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

[REDACTED] ADULT REGISTRATION FORM

Permission: [illegible] Address: [REDACTED]

Name: [REDACTED] CAUC[asian] 2 a [illegible] [REDACTED] Age: Weight: Height: Occupation: [REDACTED] Date of Birth: [REDACTED] Sex: [REDACTED] Present Address: [REDACTED] City: State: Zip Code: Phone: [REDACTED]

Check Only One Please: High School Attending D id Not Complete College, Master, over [illegible] of Attending Advanced Graduating

Other: [REDACTED]

How did you learn of this c[enter]? (Check Only One Please) A Sport Is Born" Movie Magazine Article Sports Snow (Which) Yellow Pages Ad World Championship 1962 Friend (Name) Word of Mouth [illegible]

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 the care or order of any doctor for any physical infirmity or chronic ail- ment, or other of any [illegible] that [illegible] or have corrective lenses, and that I have never been refused [illegible] for any of the following:

1. Cardiac or [illegible] condition or [illegible] 5. Nervous disorder 2. [illegible] or [illegible] condition 6. Diabetes 3. Fainting [illegible] or [illegible] 7. Kidney or related diseases 4. [illegible] of [illegible]

[Signature block REDACTED]

IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE TURN FORM OVER -- READ AND COMPLETE OTHER SIDE

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PARACHUTING CENTER ADULT REGISTRATION FORM

[Same form fields as upper copy, largely REDACTED]

Name: [REDACTED] CAUC[asian] [REDACTED] Phone: [REDACTED] Occupation: [REDACTED] Date of Birth: [REDACTED] Present Address: [REDACTED] City: [REDACTED] State: [REDACTED] Zip: [REDACTED]

Check Only One Please: High School Attending D id Not Complete College, Master, [illegible] Attending Graduated

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

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 the care or order of any doctor for any physical infirmity or chronic ail- ment, or other of any [illegible] and have corrective lenses, and that I have never [illegible] for [illegible]:

1. Cardiac or [illegible] condition or eliminate 5. Nervous disorder 2. [illegible] 6. Diabetes 3. Fainting [illegible] 7. Kidney or related diseases 4. [illegible]

[Signature block REDACTED]

IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE TURN FORM OVER -- READ AND COMPLETE OTHER SIDE

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DB Cooper-26851

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b6 b7C