First Name:       


Last Name:        


Home Address :    


Date of Birth :   (dd/mm/yy)  HKID# : 


Sex : Male  Female   Occupation : 


Company Name :    


Company Address : 


Contact Phone :     Facsimile : 


Radio Pager :       Mobile Phone : 


Internet E-Mail Address (Optional) : 

Are you a certified diver ?    YES   NO 


Your highest Diving Qualification ? 


You are member of BSAC CMAS PADI NAUI SSI YMCA(NSP) 

Notification by :  Post   Fax   Phone   E-Mail 

MEMBER DECLARATIONS:


I hereby confirm that all information specified are true & correct.