Membership Registration

Fill out this form for each member to be registered. Your membership will not be active until you have completed your payment via PayPal in the next step. Register your primary Family Membership prior to registering other family members.

IMPORTANT: each member must MAIL a signed liability waiver before your membership is fully activated. We require this form be signed EVERY YEAR. Please go to our Liability Release page to download the form and mail to the address indicated.

Type:   Adult Membership $ 39.95
  Junior Membership $ 9.95
  Teen Membership $ 29.95
  Family Membership $ 69.95
  Family Member (under a Family Membership) $ 0.00
Primary Family Membership Email:
Last Name:
First Name:
Address:
Address 2:
City:
State/Province:
ZIP/Postal Code:
Country (if not USA):
Phone Number:
Cell Number:
Your Email:
Date of Birth:
Marital Status: Married Single
Sex: M F
Certifying Agency:
Level of Certification:
Year Certified:
Additional Specialty Certifications:
Number of Dives:
If not certified would you be
interested in becoming certified?		 Yes No N/A
Emergency Contact:
Emergency Contact Phone:
Newsletter: Yes! I would like to subscribe to the team newsletter