LAKE NORMAN DIVE CLUB

Member PIEDMONT DIVING AND RESCUE ASSOCIATION, INC.

for NEW MEMBERSHIP

Application for Membership

In consideration of benefits to be derived, and in view of the fact that Piedmont Diving and Rescue Association (PDRA), Inc. is an educational institution, membership in which is voluntary, and having full confidence that every precaution will be taken to insure Safe activities, I waive all claims against the leaders of these activities, and officers, agents and representatives of PDRA and Lake Norman Dive Club. This waiver will remain in effect for the duration of continuous good standing membership.

          LNDC/PDRA New Member fee & dues for calendar year, prorated; If joining

                        (Jan thru Mar)$70.OO, $65.00(Apr thru Jun), $60.00(Jul thru Sep), or $55.00(Oct thru Dec).

       Each Additional DIVING Family Member

              $10.OO (Jan thru Dec)

Name _______________________________________________________ Home Phone__________________

Address______________________________________________________Work Phone___________________

            _______________________________________________________Cell Phone____________________

            _______________________________________________________E-Mail_______________________

In case of emergency, contact _________________________________________________________________

Address___________________________________________________________ Phone__________________

Skill Levels:

    Organization                                      Certification                                                      Certification Number

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Specialities:

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Interest:

Return to: L.N.D.C.   Attn.  Lisa Rollins

                                    6646 Pleasant Oaks Circle

                                    Charlotte, NC 28216

Signed:________________________________________­­­­__________