Membership Inquiry

Please complete the following and submit it, or stop by any Thursday night meeting and ask for an application.

Membership Inquiry
First & Last Name


email address 


Telephone Number 


What town do you live in?


Date of Birth 

How Long Have You Been Diving?

Less than 1 month
less than 1 year 1 - 3 years
3 - 5 years 5 - 10 years
More than 10 years

Certification 
PADI NAUI YMCA NAUI SSI OTHER