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Aquatic Voyagers Scuba Club

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Aquatic Voyagers Scuba Club

Home
About
Membership
Calendar
Contact

Membership Form

Thank you for using the form to apply or renew your membership with AVSC. Please complete this form and submit your membership fee via Zelle to avscscubapayments@gmail.com.

Name *

First

Last

Email *

Phone *

Address

Emergency Contact *

Emergency Contact Phone *

Are you a member of NABS?

Yes
No

NABS ID number

Certification Level *

Non-Diver
Open Water
Advanced Open Water
Rescue Diver
Master Scuba Diver
Dive Master
Instructor

Certifying Agency *

PADI
NAUI
SSI
Other

Type of Diver *

Recreational
Technical
Public Safety

Number of Dives Logged

Zero
1-50
51-99
100+

Dive Insurance Carrier *

How did you hear about us? *

Friend or Associate
Facebook
Twitter
Google+
Meetup
Other

Type of Membership *

Initial Individual 1 year - $50
Initial Individual 2 years - $80
Renew Individual 1 year - $40
Renew Individual 2 years - $60
Initial Family Membership 1 year - $70
Initial Family Membership 2 years - $120
Renew Family Membership 1 year - $60
Renew Family Membership 2 years - $100

Signature *

Clear Signature

PayPal Commerce *

Card Number

Expiration Date

Security Code

Card Holder Name