Club Membership Application Form

Please note

  • This form will take approximately 10 minutes for you to complete.
  • You will need your training records and dive logs handy for your last 10 dives.

    Personal Details

    First name
    Surname
    Address
    Area
    Town/City
    Postcode
    Home telephone
    Mobile
    email
    Date of Birth

    Dive History

    		 (Where applicable)

    Previous Dive Club
    Training Agency
    Date Started Diving
    Deepest Dive
    Dive Qualification
    Instructor Qual.
    Other Qualifications
    (e.g. Diver Rescue, Oxygen Administration etc.)
    		SAA Membership No.  (if applicable)
    Any Dive Incidents
    Any Medical Limitations

    Details of Last 10 Dives

    		 (Type over initial sample details)

    Dive No. Date Location Depth (mtrs) Duration Stops

     1

     2

     3

     4

     5

     6

     7

     8

     9

     10

    Application Questionaire

    		 (Please click on checkboxs that apply and submit details where relevant)

    Are you a member of any other Dive Club?
    Name of Club
    Have you ever been expelled from another Dive Club?
    Reason
    Are you willing to assist in training & development of trainees?
    		 
    I declare the above information is correct to the best of my knowledge