Michigan Underwater Divers Club

Application for Membership: 

This is a volunteer organization and relies on our membership to donate their time in support of our various activities. 

PERSONAL DATA (Please Print Clearly)

Name: ___________________________________Date __________________

Address: ________________________________________________________

City:  ________________________________ State_______  Zip: ___________

Home Phone (______) __________________Cell Phone: ________________

E-mail: ______________________ Over 18:  Yes / No     DAN Member: Yes / No

DIVING CERTIFICATION AND EXPERIENCE:

Certifying Agency:   ___________________ Cert. No.__________ Date ______

Highest Level of Certification:  ___________ Cert. No. _________ Date_______

How Many Dives __________Where were you certified? __________________

Certifying Instructor: _______________________________________________

Type of diving do you like:

(ie: boat, shore, grubbing, wreck, river, quarry, cavern, treasure hunting, photo/ video, ice, etc)  

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 Dives during the past two years? 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 Family Members:

Name (Spouse/ Significant other): ________________________ Diver:  Yes / No

Additional family members:

______________________   _________________    ______________________

 Membership includes: Diver, diving or non-diving spouse and minor children under 17.

                         Membership Dues:  $15.00 (annually, not prorated) 

Membership expires each year on December 31.

_____________________________________________________________________________

 NOTE:

All membership applicants must be voted in to the club at a regular membership meeting. In consideration of my (our) being admitted as a member of the Michigan Underwater Divers Club, I (we) hereby release fully and forever the Michigan Underwater Divers Club, and its members, from any and all accidents which may be incurred while participating in Club activities. In addition, I (we) do hereby agree to adhere to the stipulations of the Constitution and By-laws of the Michigan Underwater Divers Club.

 Date_________ Signature __________________________________________

 Date_________ Signature __________________________________________

 This is a volunteer organization and relies on our membership to donate their time in support of our various activities. Please help whenever and wherever possible.

Meetings are held at:

Andrews University,  Price Hall,  Biology Amphitheater, Berrien Springs, Mi

                 every 3rd Tuesday of each month (except December) Starts:  7:30 p.m.

Club Contacts:

Don McAlhany  (269-429-5527) muddydiver@aol.com  

Larry Steelman (269-684-4584)

Ric Kling           (269-944-5026)

Form: 3-9-2011 Rev 1