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.

 

 

HALIFAX LEATHERBACKS SCUBA CLUB

Membership Application

NAME                                                                                                      

ADDRESS                                                                                                

                                                                                                                

                                                                                                                

HOME PHONE                                              CELL                                                     

E MAIL ADDRESS                                                                                                       

CERTIFICATION INFORMATION

AGENCY                                        CERT. #                                            

LEVEL                                            # OF DIVES TO DATE:                

Nitrox Cert. Agency                           CERT. #                             

EMERGENCY CONTACT INFORMATION

NAME                                                                                                      

RELATIONSHIP                                                                                       

PHONE #'S                                                                                               

 

MEMBERSHIP FEES: $35.00                  

 

SIGNATURE                                                                                            

DATE                                                                                                       

 

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