Introductory Membership

Fill out this form for each member to be registered.

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
Newsletter: Yes! I would like to subscribe to the team newsletter

*Introductory Memberships do not include discounts for any Dive Team functions, special events, merchandise or access to the members only area. For full member benefits, please consider upgrading to a full, paid membership.