Bottom Time Dive Club

Membership Application (Please Print)

Please Check one:
Last Name: First Name: MI:
Street Address:
City: State: Zip:
Telephone:   Home:    Work:
Email Address:    Date of Birth Year:

Family Members to be included:

Name:    Diver? Date of Birth Year:
Name:    Diver? Date of Birth Year:
Name:    Diver? Date of Birth Year:
Name:    Diver? Date of Birth Year:

Diving History

Agency:   Level:    Year Certified:
Approximate # of Total Dives:
Date of Last Dive: Year:
Do you own your Equipment?     Are you a Computer Diver?
Do you have underwater Photography gear?
Please include suggestions here, or e-mail them to The Webmaster:
LIABILITY RELEASE
I hereby affirm that I have been thoroughly informed of the dangers inherent in SCUBA diving and that I fully understand the risks involved in this activity. I further agree to accept full responsibility for my own safety, health and well being while participating in any activity, diving or non-diving, sponsored by the Bottom Time Dive Club and freely and fully release its members and officers from any and all liability or responsibility for any injury or damage which I or my family members may suffer while participating in club activities. It is my intention that this release shall also be binding upon my family, heirs and administrators.
Signature:    Date:
After completing the form, please print it, sign it, and either bring it to a club meeting with the appropriate dues amount, or mail the form and payment to:
Bottom Time Dive Club
C/O Barrett Building Company
5201 D Sanger Ave.
Waco, TX 76710
To clear all entries.
For more information on our Club, please e-mail our Secretary
For the current membership dues table, see Members

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