Part 64, page 402

Transcript

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

ADULT REGISTRATION FORM

[Fields visible but mostly illegible due to copy quality]

Name: [illegible] N.Y. City: [illegible] Occupation: [illegible] Date of Birth: [illegible] Present Address: [illegible] City: [illegible] State: [illegible] Phone: [illegible]

(Check Only One Please) Male / Female Height: [illegible] Weight: [illegible]

How did you learn of this 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

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

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify that I am not under a doctor's care nor under treatment for any physical infirmity or chronic ailment, or if any of my [illegible] not [illegible] normal vision or have corrective lenses, and that I have [illegible]

1. Cardiac or pulmonary malfunction or disease 2. High or low blood [guess: pressure] 3. Fainting spells or convulsive seizures 4. [illegible]

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

Date: [illegible]

TURN FORM OVER READ AND COMPLETE OTH[ER SIDE]

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PARACHUTING CENTER ADULT REGISTRATION FORM

[Second copy of the same form, largely identical content]

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

How did you learn of this center?

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

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING

I hereby certify that I am not under a doctor's care nor under treatment for any physical infirmity or chronic ailment, or if any of [illegible] this [illegible] normal vision or have corrective lenses, and that I have [illegible]

1. Cardiac or [guess: pulmonary] malfunction or disease 2. High or low blood [guess: pressure] 3. Fainting spells or convulsive seizures 4. [illegible]

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

Date: [illegible]

IMPORTANT -- AFTER READING, SIGNING AND DATING THIS .05F -- TURN FORM OVER -- READ AND COMPLETE OTHER SIDE

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DB Cooper-26852

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b6 b7C