Membership Inquiry

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

Membership Inquiry

First Name 


Last Name 


email address 


Certification 
PADI NAUI YMCA NAUI SSI OTHER

Date of Birth 


Telephone Number 


Fax 


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