The Atlantic Wreck Divers, Inc.

Application for Membership

Name_____________________________________________________   Date ___________________

Address ____________________________________________________________________________

____________________________________________________________ Zip ___________________

Home Phone (______)____________________   Office Phone (________)________________________

e-mail address _______________________________________________________________________

Age _____________          Occupation ____________________________________________________

Certification (NASDS, NAUI, PADI, etc.) ________________________   Cert. No. ________________

List three wreck dives (within the last two years) that you have made.
Give the wreck’s name, location, depth , date and name of the dive boat or captain.

(1)  __________________________________________________________________________________

(2)  __________________________________________________________________________________

(3)  __________________________________________________________________________________

Other diving experience  __________________________________________________________________

_____________________________________________________________________________________

Special Interests (artifact collecting, photography, spearfishing, etc.) ___________________________________

_____________________________________________________________________________________

Other information relating to you diving interests and experience? ____________________________________

_____________________________________________________________________________________
 

Your signature below indicates your willingness to abide by the safety rules of the club and to abide by the constitution and by-laws of the club.
 

Signed:  _________________________________________________    Date  _____________________
 

Mail this form, the $10.00 initiation fee and the signed waiver form to:  

The Atlantic Wreck Divers, Inc.

Contact Karen Flynn at 410-975-0577 or via email at karenflynn@cablespeed.com