On-Line Membership Application Form
Date of Application M/D/YYYY:
Date of Birth M/D/YYYY;
Work Phone: (will not be
added to club contact "mailing" list)
Cell Phone: (will not be
added to club contact "mailing" list. May save you a trip if the
weather turns bad)
If referred by a current NDA Member, Please add name here;
Medical Information and Emergency
The following information
will be carried in the club's Dan O2 kit on club dives.
Certifications and Experience
Statement of Understanding
Please make the
appropriate selection in each box for each paragraph and realize that submitting the form is the
equivalent of signing your signature.
hereby confirm that I have read, understand and agree to abide by the Niagara
Divers' Association Rules and Regulations and Policies and Procedures when
participating in any Club dive.
2- I also
understand that scuba diving is a hazardous activity in which serious injuries
and even fatalities occur. By
participating in a Club dive, I acknowledge that I am voluntarily assuming the
risk with full knowledge of the dangers inherent in this type of activity..
agree to engage only in the type of diving for which I am certified by a
recognized training agency.
4- I am
also aware that some of the sites selected for Club dives are located in
remote areas where emergency medical treatment facilities, including
hyperbaric chambers, are not easily accessible in terms of distance and/or
time. Such facilities may be
critical in the treatment of a dive-related injury.
acknowledge that the Dive Coordinator appointed by the Niagara Divers'
Association is not performing the duties of a Divemaster, regardless of
whether or not he or she is certified to do so.
I understand that the Dive Coordinator may restrict my diving activity
at his or her sole discretion to ensure the safety and enjoyment of all divers
participating in the Club dive. I
agree to abide by the decisions of the Dive Coordinator on all Club dives in
which I participate.
hereby acknowledge that I voluntarily assume all risks related to my
participation in scuba diving activities organized by the Niagara Divers'
Association. I and my executors
hereby agree to waive any liability on the part of and to hold forever
harmless the Niagara Divers' Association, its Executive, Dive Coordinators
and members for any and all injuries and/or damages arising from any act or
When the Online Application form is
submitted you will be automatically taken to a confirmation
page with a link to the PayPal payment page.
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