Michigan Underwater Divers Club
This is a volunteer organization and relies on our members to donate their time in support of our various activities.
PERSONAL DATA (Please Print Clearly)
Name: ___________________________________Date __________________
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 __________ State where you were certified? ________________
Certifying Instructor: __________________________________________________
Proof of diving certification must be presented with application:
Type of diving you like:
(ie: boat, shore, grubbing, wreck, river, quarry, cavern, treasure hunting, photo/video, ice, etc.)
Types of Dives during the past two years?
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.
All membership applicants must be approved by a majority of club members at a scheduled club meeting.
In consideration of my (our) being admitted as a member(s) 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 incidents or 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______________ Name: __________________________________
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.
Club President or Authorized MUD Club Representative
Proof of diving certification reviewed: _______________
Membership Acceptance Date: ____________
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 Contact: MuddyDiver@aol.com
Club Website: http://mudclub.scubaobsessed.com/
Membership Request Form Rev 4 – 2015-09-11