Company Logo

Main Menu

Courses

Products

Dive Club

Offers

Gallery

Home Membership Application Form
Hollis

Dive Club Application

Generated with MOOJ Proforms Basic 1.1
* Required information.
Name * Your full name
Surname * Your Surname (family name)
Address * Your full mailing address
Mobile Phone number * Your mobile phone number
Your Email * Your Email Address
ID Number * Id number or Passport Number
Date of Birth * Your date of birth
Select events you are interested in * Please select the events you are interested in. You will be informed of events of the items you have selected
Scuba Diving
Technical Diving
Wreck Diving
Nitrox Diving
Trimix Diving
Wreck Penetration Diving
Boat Diving
Night Diving
Camping
Water Sports
Boat Tris
Dive Trips (Local)
Dive Trips (Inernational)
Other Trips of events
Diving Qualifications Please list your divign qualifications
Would you like to Receive SMS messages about events? *
Would you like to be a member of our Rescue Team *
T-shirt Size * We will give you a free T-shirt when you become a member so pleaser let us know what size t-shirt you will need
Small
Medium
Large
Extra Large
Extra Extra Large
Picture upload * Please provide us with a colour passport photo of yourself (25mm x 25mm) so that we can process your membership card.
Agree to terms? * By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that my application for membership is completely voluntary. Any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. I understand that there are risks involved in diving and I accept these risks and will not hold the organization, its members, the governing body or any other organization responsible for any accidents that may arise. I am over the age of eighteen and am eligible to sign this form.
Signature * Please type your full name here as a signature

mad4media user interface design

Weather

Calendar