Name:
 Birth Date:
Address:
City:
 State:
 Zip Code:
Home Phone:
 Cell:
E-Mail:
Would Like To Receive E-Mails About Trips, Events And Specials
Yes
 No
Would You Like To Receive E-Mails About Upcoming Classes And Training
Yes
 No
What Type Of Diving Do You Like ?
Florida Springs
 Reef Diving
 Aquarium Diving
Ocean Diving
 Cavern Diving
 Lake Diving
Wreck Diving
 Cave Diving
 River Diving
Fossil Diving
 Tech Diving
 Low/No Vis Diving
Quarry Diving
 Deep Diving
 Any Type Diving
UnderWater Photography
 Spearfishing/Hunting
Are You Interested In Local Dive Trips (Quarries, Lakes) Or Overnight
Travel Trips (Weekends, Two Or Three Day Trips Or Longer)?
Local Trips
 Weekend/Three Day Trips
4-5 Day Or Longer Trips
 Fly/Dive Or Out Of Country Trips
LIve Aboard Trips
What Is Your Present Certification Level:
Junior Scuba Diver
 Master Diver
 Nitrox Diver
Open Water/Scuba Diver
DiveMaster
 Heilox
Advanced Diver
 Instructor
 TriMix
Rescue Diver
 Cavern Diver
 Deep Diver
UnderWater Hunter
 Intro To Cave
 Wreck Diver
Public Safety Diver
 Cave diver
 Tech Diver
I'm Not A Diver, Just Interested
Do You Own Your Own Equipment?
 Yes
 No
Are You Interested In Advancing Your Diving Education And Skills ?
Yes
 No
 Thinking About It
Would You Like For This Information To Be Entered In Our Dive Club
Database And Become A Member Of Our Dive Club?
"Shark Bait Dive Club"
Yes
 NO
 Let Me Think About It
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Will Help Us Plan Trips, Dive Training And Just General Get Togethers With
Other Person, Agency, Company Or Entity Of Any Type.

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GSDS