PENINSULA RIVER RATS
SCUBA DIVERS ASSOCIATION
I certify by my signature that I am interested in the sport of scuba diving and the promotion of camaraderie through safe diving. I further certify all the information I provide below is accurate and truthful. I acknowledge the potential hazards and dangers incidental to engaging in the activities of scuba and relieve members of this association from liability for any personal injury, property damage or wrongful death caused while engage in scuba diving activities with association members. I assume these risks myself, and acknowledge I am responsible for my own safety during diving activities.
NAME:
________________________ EMAIL: ______________________
DIVING
FAMILY MEMBERS: ___________________________________
ADDRESS:
________________________CITY:___________ ZIP :______
PHONE:
(H) ___________(W)______________(Cell/Pager)____________
Number
of Dives: _______Hours: _____Date Last Dive: _______
River Rats success depends on members taking an active part, both in supporting the dive activities and in volunteering time to coordinate activities. Please list any areas where you are willing to help and/or strengths that would benefit the association.
SIGNATURE DATE PARENT’S SIGNATURE IF 17 OR LESS
RIVER RAT OFFICER (verification of certification) DUES PAID YEAR – MEMBER NUMBER
NOTE: Membership dues are $15 a year for individual or family membership. Make check out to the “Peninsula River Rats” and give or mail to the association treasurer: Mr. Doug Muller, 120 Fairmont Av., Hampton, VA 23666. Membership is valid for the calendar year, if you join as a new member after September 1 dues carry over to the next calendar year.
Renewing members are only required to update information already on record that has changed but must sign the application.