Join/Renew

Please complete the membership application form below. Once your membership application has been processed you will be emailed payment instructions.

Member Registration Form

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Cell Phone

Email(Required)

Enter Email Confirm Email

Date of last dive and number of dives in past 12 month

Total Number of Dives

Equipment set used most often (CCR, OC single, side mount, or back mounted doubles)

Certifications (Add as many as you wish)

Certification

Agency

Date

Emergency Contact Info (Two Required)(Required)

Name

Relationship

Phone

Cell

DAN Member Number

Other Pertinent Information

Select Membership Type

Annual Dues Individual $30

Annual Dues Family $35

5 Years $100

Lifetime $500

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