Part 70, page 98

Transcript

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

ADULT REGISTRATION FORM

[illegible] b. [illegible]

High School [illegible] [illegible] Date of Birth: [illegible] [illegible] Address

City [illegible] State [illegible]

How and you [guess: learn] of Check Only One Please A [guess: short] in a [guess: Movie] Magazine Article Sports Show [guess: WWII] Yellow Pages Ad World Championship 1962 Friend [Named] Word of Mouth [guess: Lecture] Other

HOW DID YOU TRAVEL TO CENTER?

Plane to [illegible] + Bus [illegible] Other

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ADULT REGISTRATION FORM

[illegible fields]

Date of Birth [illegible] [illegible] Address

City [illegible] State [illegible]

Race [illegible]

HOW DID YOU TRAVEL TO CENTER?

Plane to [illegible] + Bus [illegible] Other

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ADDITIONAL STATEMENT FOR UNDERGONE PARACHUTE TRAINING AND JUMPING

I [guess: hereby] certify that I [guess: have] not any [guess: current] or [guess: past] [guess: under] treatment for any physical infirmity or chronic ail- ments, or history of any [guess: surgery, that] I do not [guess: require] [guess: corrective] lenses, and that I have [illegible] [guess: no] [guess: defects] [illegible] for [guess: any] of the [guess: following]:

1.] Contacts or [guess: glasses] or [guess: prescription] [guess: lenses] or [guess: devices] 2.] 3.] 4.]

5.) Nervous disorder 6.) [guess: Diabetes] 7.) Kidney or related diseases

Date [illegible]

THIS FORM OVER - READ AND COMPLETE OTHER

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PARACHUTING CENTER

ADULT REGISTRATION FORM

Check Only One Please

High School .1 Attending .? [guess: Did] Not Complete . Checked

[guess: College] [guess: or] [guess: other] [guess: name] of .1 Attending .2 Attended .3 [guess: Graduated]

[guess: Other]

How did you learn of this center? (Check Only One Please) [guess: A] "A Sport is Born" Movie Magazine Article Sports Show [guess: WWII] Yellow Pages Ad World Championship 1962 Friend [Named] Word of Mouth Lecture Other

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

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MEDICAL STATEMENT FOR UNDERGONE PARACHUTE TRAINING AND JUMPING

I [guess: hereby] certify that I am not [guess: and] have not [guess: ever] [guess: been] [guess: under] treatment for any physical [guess: infirmity] or chronic ail- ment, or [guess: any] [guess: of] [guess: any] [guess: nature] or [guess: that] I have [guess: corrective] lenses, and that I have

1.) [guess: Contacts] or [guess: glasses], [guess: or] [guess: prescription] [guess: lenses] 2.) [illegible] 3.) [guess: Fainting] or [guess: dizzy] or [guess: convulsions] 4.) [guess: Heart] or [guess: circulatory] [illegible]

5.) Nervous disorder 6.) [illegible] 7.) Kidney or related diseases

Date [illegible]

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

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DB Cooper-29849