Membership Application Form & Agreement

We want to assure you that we will always respect your privacy.

NAME

AGE

GENDER

		MALE
		FEMALE

ADDRESS

HOME PHONE

CELLULAR

E-MAIL ADDRESS

What is your Agency? (PADI, NAUI, CMAS, I.D.E.A. SSI...)

AGENCY
OTHERS

What is your level?

Over fishing and using fishing spear while diving is prohibited

		AGREE
		DISAGREE

I understand that it is my responsibility to be aware of current sea conditions and dive according to my certification level and experience.

		AGREE
		DISAGREE

I understand that the MERMAID OKINAWA club shall not be held liable in the event of any injury or death.

		AGREE
		DISAGREE

NOTE

Please click "Submit"to complete your resistration 。