If you would like to become a member of The Halifax Leatherbacks Scuba Club, simply print and fill in the form below and drop in to Divers World to pay your fees. The form is also available in PDF or Microsoft Word versions.

HALIFAX LEATHERBACKS SCUBA CLUB

Membership Application

NAME                                                                                                      

ADDRESS                                                                                                

                                                                                                                

                                                                                                                

POSTAL CODE                                                                                       

HOME PHONE                                              CELL                                                     

E MAIL ADDRESS                                                                                                       

CERTIFICATION INFORMATION

AGENCY                                        CERT. #                                            

LEVEL                                               

# OF DIVES TO DATE:                      

EMERGENCY CONTACT INFORMATION

NAME                                                                                                      

RELATIONSHIP                                                                                       

PHONE #'S                                                                                               

MEMBERSHIP FEES:

MAY 01 TO APRIL 31: $35.00                  

SIGNATURE                                                                                            

DATE