Lake Wazee Annual Dive Pass signup form

An annual dive pass is $75.

Name  
Address  
 
Phone number  
Email address  
Driver license number   state  
Date of birth  
Diver certification agency   level  
Dive Insurance agency & policy number  
Signature   Date  

Make check for $75 payable to:

Rochester Scuba & Snorkel Club
c/o Dan Lovik
1504 7th St NE
Rochester, MN 55906
Treasurer Use Only
Membership current?   ___ Yes
  ___ No

We'll send your application to Jackson County Parks and your annual Lake Wazee dive pass will be mailed directly to you.