Atlantic Rangers Scuba Club Membership Application
Thank you for using this form to apply for ATRA membership. 

Annual dues are $50 (Associate Members) and $75 (Full Members).  Note: Full membership must first be approved.

Dues are payable January each year (deadline 3/31) via:
  • Zelle: payment@atlanticrangers.org
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Today's Date *
MM
/
DD
/
YYYY
Last Name *
First Name *
Street Address *
City *
State (two letter abbreviation) *
Zip Code *
Home Phone (XXX) XXX-XXXX *
Mobile Phone (XXX) XXX-XXXX *
Is it okay to contact you via SMS/Text? *
Email Address *
Date of Birth (XX/XX/XXXX, year optional) *
Highest Certification Level (select one) *
Specialty Certifications (select all that apply) *
Required
Diving Certification Agency (if applicable)
Dive Insurance Agency *
Dive Insurance ID Number (if applicable)
How did you hear about ATRA? *
What skills or experience do you have that are relevant to ATRA's mission?
Where would you like to see the club travel for a future dive trip?
What is your main interest in joining ATRA?
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