SCUBA Clubs

First Name

Last name 

Address 

City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia FS Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Is. Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota No. Mariana Is. Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Is. VIRGINIA Washington West Virginia Wisconsin Wyoming Other Zip

Email Address          

Phone area code             Number 

Age Group  under 16   under 21   21-30   31-41   42-56   above 56

What Locations are you most interested in diving?

  Southern California (Catalina, Santa Barbara Island, San Clemente Island, San Nicholas Island, Anacappa Island, Santa Cruz Island, Santa Rosa Island, San Miguel Island, Begg Rock, Cortez Banks)

  Western Pacific (Truk Lagoon, Palau, Yap, Solomon Islands, Fiji)

  Caribbean (Bahamas, Cayman Islands, Barbados, West Indies, Virgin Islands, Turks and Caicos, Mexico)

  Europe (Mediterranean, Red Sea )

  Australia 

  Hawaii

  Marshall Islands (Bikini Atoll)

  Florida

Other (Fill in box below)

What Diving Certification do you hold?

NAUI     PADI  PDIC  SSI  NASDS    Other

I would like information on getting certified.  Yes