Please print and send to Dive Wimbledon C/O 34A Hotham Road, SW19 1BS or drop it in to our offices
Dive Wimbledon Club Enrolment Form
Name……………………………
Birth date……………………….
Address………………………………………………………………………………….
Contact number…………………………..Mobile……………………………..........
Email address………………………………………….
Certification level and Agency……………………………………………………
Number of dives…………………
When and where last dived……………………………………………………………
Dived in the UK before : Yes/ No
If yes how many dives here…………………
Want to dive in the UK : Yes/ No
Want to practise in the pool : Yes/ No
Interested in overseas holidays Yes/ No
Are you interested in any other PADI courses? Yes/ No
If yes please tick those from the list below.
Advanced Open Water
Emergency First Response
Rescue
Divemaster
Master Scuba Diver
Drysuit specialty
Equipment specialty
Deep specialty
Navigation specialty
Wreck specialty
Enriched Air specialty
Photography specialty
Digital Photography specialty
Peak Performance Buoyancy
PADI Oxygen Provider
…………………………………………………………………………………………..
Payment method
Cheques can be made out to Dive Wimbledon Club and posted to 34A Hotham Road, South Wimbledon, SW19 1BS. Alternatively you can pay directly into the club account online. Account number 86582917 Sort Code 60-24-06. Please also send one passport photo.
Total – Half year Individual £40 ____ Annual Individual Membership £55 ____ Annual half year Joint £65 ____ Annual Joint £100 ____ Annual Family Membership £140____