BAY AREA DIVERS MEMBERSHIP APPLICATION

 

Note: if renewing and your information has not changed please write in the ‘Address’ section ‘no changes’

Please provide birth month and day so we can make sure that our records are up to date

 

NEW____      RENEW _____                                           DATE: ______________

 

                   JANUARY – DECEMBER                  Individual ($15)   _______   Family ($20) ______

 

 Half Yr (New Only) JULY – DECEMBER            Individual ($7.50)   _______ Family ($10) ______

 

Name: _________________________                  Birth Date: Month ______  Day ______

 

E-mail Address: ________________________________________

 

Partner: ________________________                  Birth Date: Month ______  Day ______

 

E-mail Address: ______________________________ (if different)

 

            Address:    ___________________________________________

                             ___________________________________________

                             ___________________________________________

 

            Telephone:        Home: ________________________ Work: ________________________

 

Publish in BAD Directory:  Yes ___ No___

 

I wish to receive the BAD newsletter at the e-mail address above ______

or by US Mail at the address listed above ______

 

Diving Experience / Location: _________________________________________________

Diving Interest: __________________________________________________________

Other Hobbies, Interests: ____________________________________________________

 

Family Members to be included on Family Membership:

 

Name 

Birthday - Month / Day

Dive Classification

Email Address (if different)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                    

Bay Area Divers, Inc    P. O. Box 58404    Houston, TX 77258-8404

REVISED    10/2009