Lazy Seal Freediving Club - Membership form
Please read first
The first part of this form (Personal details) is mainly optional, but would be very useful for us to keep our database up-to-date and to keep you informed as to what is going on in the freediving community.

The second part (Fees and payment) is compulsory.

The third section (medical statement) is compulsory if you are renewing your membership. If you've started with us very recently, you should have already filled it as part of the New diver form.

Personal details
First name *
Your answer
Last name *
Your answer
Street
Your answer
Suburb
Your answer
Town
Your answer
Postcode
Your answer
Phone - cell *
Your answer
Phone - home
Your answer
Phone - work
Your answer
Gender *
Date of birth *
MM
/
DD
/
YYYY
Nationality *
Your answer
Email *
Your answer
Please tick if you wish to receive information from the club by email
Name of emergency contact *
Your answer
Their relationship to you
Your answer
Their phone number *
Your answer
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