Class Sign Up Sheet

Filling out this form does not guarantee a spot in class. Divers can reserve their spot by paying with a credit card over the phone or by dropping off payments to our visiting center.

Class Sign Up Sheet

First Name: *

Middle Name:

Last Name: *

Birth Date:

Height:

Weight:

Email Address: *

Mobile or Best Phone #:

Sex:

Female

Male

Address:

Street:

City:

State: -- State -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip:

Personal Info

Class Type: * Adventure Open Water W/ Equip. - $800 Adventure Open Water No Equip. - $900 Challenge Refresher - $250 Private Open Water W/ Equip. - $900 Private Open Water No Equip. - $1000 Private Pool Refresher - $150 Open Water W/ Equip. - $500 Open Water No Equip. - $600

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