Vancouver Apneist Club :: membership form ::

Membership Registration Form

* required field

Name*:
Address*:

City*:
Province*:
Postal Code*:
Home Phone*:	Work Phone:
Email*:	Website:
Birthday:
Are you a snorkeler?		Yes No
Are you a SCUBA diver?		Yes No
Are you a freediver?		Yes No
If you answered "Yes", have you had any formal training?		Yes No
If you answered "Yes" please explain:

Are you interested in competitions?		Yes No
Do you own any freediving gear?		Yes No
How did you hear about Vancouver Apneist Club*?