Name Street City Postal code E-Mail Business Phone Residence Phone Date of birth: (mm/dd/yy)
Medical Problems
Name Phone Relationship Name Phone Relationship
Check highest level certified: StudentOpen WaterAdvancedDivemasterAssistant InstructorInstructor C-Card # for above Agency Year Certified
First Aid Year CPR Year
List specialty courses:
How many dives did you do last year? If you are a certified Divemaster, would you lifeguard the pool? If you are an Instructor, would you teach a club course?
Basic Course Advanced Course Divemaster Rescue First Aid/CPR Assistant Instructor
Roatan Fenlon Lake Erie Tobermory Penetang Brockville Niagara River Kingston Rockport Segwun Dinner Cruise Turks and Caicos
Thank you for completing the Toronto Super Turtles Membership Application form. Send your $50.00 membership fee to:
Toronto Super Turtles Dive Club 1045 Longbow Dr. Pickering, Ontario L1V 5W3