NARC DIVE CLUB MEMBER REGISTRATION FORM
( print, complete and post or drop into the shop)
Personal Details (“PLEASE PRINT CLEARLY”)
These details are to be held confidential and only shared between 'Diving Frontiers' and the 'Narc Dive Club'.
Name: ___________________________________________Date of Birth:________________________
Email Address: ______________________________________________________________________
Home Address: Suburb:________________________________________________________________
City: _________________________State:___________________ Postcode: ______________________
Mobile Phone: ______________________________Home Phone: ______________________________
Emergency Contact Details
Name: __ ________________________________________Relationship: ________________________
Home Phone: __ __________________________________Mobile Phone: ________________________
Address:__ ___________________________________________________Post Code:______________
Diving Details
Diving Organization(s): ____________________ Highest Certification level:_______________________
Date of First Cert: __ _______________________Date of Most Recent Cert: _______________________
Number of Logged Dives: __ __________________________Last Dive:__________________________
Equipment Details
Own Equipment: Yes / No.
If “NO” then complete the following:
Wetsuit Size __ _____Boots_______ Fin s_______ BC D_______ Weight Lb s_______ Hood __________
Disclaimer
In signing this disclaimer, I agree to abide by the terms and conditions (Attached) of the Narc Dive Club
and follow
the PADI Diving and Snorkeling Codes of Practice (Attached) and safe diving practices
(Attached) to the best of my ability. Please ensure these forms are also attached to your application form
can be either faxed to the Shop on (08) 9240 6214 or dropped into the shop together with your payment.
Sign _______________________________________________
Name ________________________________________________________ Date _________________
................................................................................................................................................................................................
STAFF ONLY:
Name of staff member ___________________________________________ Date: ________________
 Sighted card  PADI Dive Check Other :____________________________________________
EVE updated Club Membership Payment process Club Membership Number:_____________
Completed by Staff Member name:________________________________ Date:___________________
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