JCU Dive Club Member Details
Membership type
*
Annual
Lifetime
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address (Residential)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
*
/
Day
/
Month
Year
Date
Dive Qualification
*
None
Open Water
Advanced Open Water
Rescue Diver
Dive Master
Instructor
Tech Diver
Qualifying Agency
PADI, SSI, etc
Number of dives
If more than 100 round down to the nearest multiple of 50
Maximum Depth (meters)
What is your deepest dive? In meters.
Dietary Requirements
*
We need to know this for event planning and liveaboard trips.
Emergency Contact Details
*
First Name
Last Name
Relationship to Member
*
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you wish to subscribe to the JCU Dive Club Newsletter
*
Yes
No
Do you give JCU Dive Club permission to use photos of you taken at our events?
*
Yes
No
I agree to follow the JCU Dive Club Member Code of Conduct
*
Yes
Code of conduct can be found at www.jcudiveclub.com, on our facebook page or via this link (https://drive.google.com/file/d/1dmaRdL3ijXuSU46sg7uqMxOAeSfZZXrx/view?usp=sharing)
Submit
Should be Empty: