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Form 203
(Rev. 7-1-40)

THE UNITED STATES OF AMERICA
CIVIL AERONAUTICS AUTHORITY
WASHINGTON

[[line]]

RELEASE

KNOW ALL MEN BY THESE PRESENTS that I, [[blank space]] (Full name), [[blank space]] (Address), in consideration of the permission granted to me by the United States Government through its officers and agents, to be carried in certain aircraft of the Civil Aeronautics Authority, do hereby assume all risk of personal injury, loss of life, and all loss of or damage to property from whatever cause arising, and expressly agree to release the United States Government, its officers, agents, or employees from liability therefor. 

In testimony whereof I have set my hand and seal this [[blank space]] day of [[blank space]], 194 [[blank space]]

[[blank space]] (Signature) (Seal)

[[blank space]] (Witness) 

[[blank space]] (Name of pilot)

[[blank space]] (Identification mark of aircraft)

16-15907