Wet and Wild Membership

Complete this form AND the waiver, and mail to:
Daniel Gauthier  122 Arsenault Cr., Ft. McMurray, T9J 1J6
Cheques should be made out to Wet and Wild Diving Society

Name(s):

Age:

Address:                                                                                                                        Postal Code:

Phone Number:

E-mail address:

Certification Card number:

Courses achieved:

Courses interested in:

How the society can support your improvement as a diver:

Ways you would like to help out the Wet and Wild Society:

Money enclosed:

________________x $30 per Wet and Wild adult

________________x free for age 21 and under

________________x $15 for individual, $25 for 2 years for individual
$25 for family, $45 for family.  (optional) (Free for first year for new members)

________________ Total Enclosed