False Bay Underwater Club
Membership Application Form & Waiver and Indemnity
I, (hereinafter referred to as 'The Diver'), hereby wish to apply for membership to the above-mentioned. By completing and submitting the below form, I agree to abide by the rules and constitution of the False Bay Underwater Club, as amended from time to time. The Diver gives permission to be added to The Club WhatsApp groups as well as photos in which The Diver is featured to be used on social media.
Furthermore, I am bound to the "Waiver and Indemnity" below.
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Email Address: *
Surname *
Full Name *
Home Address:  *
Postal Address:
Business Address: 
Occupation: *
South African ID number, or Passport Number if not a South African citizen
Date of Birth *
MM
/
DD
/
YYYY
Medical Aid Name:
Medical Aid Number
Divers Alert Network (DAN) Membership Number:
Mobile Number: *
Work Number:
WhatsApp Number:
Next of Kin Names: *
Next of Kin Contact Numbers: *
Membership of Previous Club:
Any additional allergies or medical information:
Qualifications: *
Required
If you selected Other above, please elaborate:
Dive Certification Number (PADI, SSI, RAID, etc) *
Diving Related Interests: *
Required
If you selected Other above, please elaborate:
Date of Last Dive: *
MM
/
DD
/
YYYY
Date of Last Dive Medical:
MM
/
DD
/
YYYY
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