Please circle the amount corresponding to:
- your membership level (individual or family)
- either "annual renewal" or the month that you're joining as a new member
|
| |
Annual Renewal |
New Membership |
| Jan |
Feb |
Mar |
Apr |
May |
Jun |
Jul |
Aug |
Sep |
Oct |
Nov |
Dec |
| Individual Membership |
$25 |
$24 |
$22 |
$20 |
$18 |
$16 |
$14 |
$12 |
$10 |
$8 |
$6 |
$4 |
$2 |
| Family Membership |
$50 |
$48 |
$44 |
$40 |
$36 |
$32 |
$28 |
$24 |
$20 |
$16 |
$12 |
$8 |
$4 |
| Name |
| Address |
| City |
State |
Zip |
| E-mail
| Phone |
| IMPORTANT: Club notices and the newsletter are delivered through e-mail.
We won't divulge your address to evil spammers. |
| Certification level and # |
Years diving |
Additional names for family membership
|
| |
| |
| |
Print out this form, fill it in, include a check payable to Rochester Scuba & Snorkel Club and mail to:
Rochester Scuba & Snorkel Club
c/o Dan Lovik
1504 7th St NE
Rochester, MN 55906
Thank you!
|
