Scubadillo Dive Club

Membership Form

Membership Status*

New
Renewal

Membership Type*

Individual ($36.50)
(includes $1.50 online transaction fee)
Family ($51.50)
(includes $1.50 online transaction fee)

Total

$36.50

Note: Divers will be asked to sign a Liability Release before participating in club dives. They should also carry dive insurance.

Member Information

Name*

Date of Birth

Certified Diver*

Yes
No

Emergency Contact

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Phone*

Would you like to be involved in a committee?

Local Dive
Ocean Dive
Social
Membership

Join the Scubadillos' E-Mail List

By submitting this form you are authorizing Scubadillo Dive Club to use photographs or videos taken at club events, in which your image may appear, as promotional material for the club in electronic or print media without expecting payment. As respects family memberships, you are also authorizing the use of images of minor family members in said promotional material.

Billing Information

Name*

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

Phone Number*

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