Part 81, page 291
Document date 4 December 1971
FBI 164-81, Vault Part 81 p. 291 (DB Cooper-35761), Form, dated 4 Dec 1971 — cooper.theunsolved.net/parts/Cooper-Part-81/pages/291
Transcript
The scan is the source; the transcript is machine-generated from it.
A- 45410 164-2111 039 LL APPLICATION TO U.S. PARACHUTE [FBI stamp] ASSOC. LABORATORY N IN NAME D.B. COOPER
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Name: D. B. COOPER Mail Address: C/O YMCA (Please Print or Type) City, State and ZIP Code: TORONTO, CANADA Phone: -- USPA No. -- Age: [blank] Sex: YES [illegible handwriting below Sex field]
FOR USPA USE ONLY: USPA No. _____ b6 b7C Postmark Date _____ Amount _____ (Ck., MO, Cash)
A. Application: I hereby apply for membership in the United States Parachute Association as indicated below. (Please Note: Membership includes annual license validation.) CHECK ONE: ☐ New Membership — $15.00 ☐ Current Member Renewal — $12.00 ☐ Delinquent Member Renewal — $15.00 ☐ Family Membership Plan: Two members of an immediate family may join USPA at a $2.00 reduction in the total cost of two regular memberships provided they join at the same time and reside at the same address. ☒ Lifetime Membership: $200.00. Includes all regular membership benefits for life.
Note: Membership, PL/PD Insurance, PARACHUTIST magazine subscription and other membership benefits expire on the last day of the twelfth month following the month in which the membership is issued. Membership dues are non-refundable.
Please sign and complete all applicable information on reverse side.
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MEMBERSHIP APPLICATION UNITED STATES PARACHUTE ASSOCIATION A Division of the National Aeronautic Association — P. O. Box 109, Monterey, California 93940 DB Cooper-35761